The Effects of Regionalization of Perinatal Care on Hospital Services for Normal Childbirth


  • Madeleine H. Shearer

    1. Madeleine H. Shearer taught expectant and new parent education for ten years. She edits Birth and the Family Journal, a medical care providers’and consumers’journal sponsored by the International Childbirth Education Association and the American Society for Psychoprophylaxis in Obstetrics. She has written 14 papers and spoken on the impact of professionalism and contraceptive and obstetric technology.
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ABSTRACT: Regionalized perinatal care first arose out of progress made in the mid 1960s in treating the sick newborn. There are three types of regionalization systems. One involves statewide transport of critically ill newborns and high-risk pregnant women to regional intensive care centers. A second system involves county-wide referral, with transport when needed, of sick newborns and pregnant women who are likely to deliver a seriously ill baby. The third system is reorganized obstetric care, which arose out of the crisis to urban hospitals of a low birth rate and government reimbursement for obstetrical care. Known as the Level I, II and HI system, it incorporates Recommendations for closing small hospital obstetrical units and setting up standards for the remaining units, including minimum occupancy rates, specialty staffing, and high-risk technology. No provision is made in this system for normal, uncomplicated childbirth care in hospitals. Effective consumer roles involve (1) alerting the community to the safety and benefits of normal childbirth, (2) publicizing the risks of obstetric intensive care which are unnecessary in normal birth, and (3) cooperating with other groups to inform governing bodies and influence legislation.