More Investment in Primary Care Would Help Mothers, Babies

In 2012, I chaired a Dr. Robert Bree Collaborative(www.breecollaborative.org) workgroup that created obstetrics care recommendations,(www.breecollaborative.org) including pay-for-performance metrics for delivery care of patients covered by the state of Washington, either through Medicaid or the state employee health insurance.

Our recommendations had three key goals:

• Eliminate all elective deliveries before the 39th week (i.e., those deliveries for which there is no appropriate documentation of medical necessity). 
• Decrease elective inductions of labor between 39 weeks and up to 41 weeks.
• Decrease unsupported variation among Washington hospitals in the primary cesarean section rate.