Childbirth is the leading reason for hospitalization in the USA and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, a report says today.

U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, the authors write. More than $2.5 billion a year is spent on unnecessary C-sections, which now represent nearly a third of all deliveries.

Reducing expensive techniques such as C-sections and increasing low-cost approaches such as childbirth assistants called doulas would improve mothers' and babies' health while cutting costs, the authors say.

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The report was produced by the Milbank Memorial Fund, the Reforming States Group of government health policy leaders; and Childbirth Connection, a research and advocacy group.

"Everybody recognizes that our health care system's in trouble," says Childbirth Connection's Maureen Corry, co-author with colleague Carol Sakala. "But when it comes to maternity care, no one talks about it."

Yet, she says, with 4.3 million babies born annually, nearly one in four people discharged from U.S. hospitals are new mothers or newborns. On the outpatient side, only checkups, follow-ups and coughs rack up more visits than maternity care.

In 2005, the average hospital charge for an uncomplicated vaginal birth was $7,000, compared with $16,000 for a complicated C-section, Corry reports. "I think a lot of people have no idea about the cost," she says.

The University of Wisconsin's Douglas Laube, a former president of the American College of Obstetricians and Gynecologists, blames "very significant external forces" for the overuse of expensive technologies in maternity care.

"I don't like to admit it, but there are economic incentives" for doctors and hospitals to use the procedures, says Laube, who reviewed the new report before its release.

For example, some doctors might get bonuses for performing more labor inductions, which adds costs and increases the risk of C-sections, which, in turn, increase hospital profits because they require longer stays.

In addition, some doctors order unnecessary tests and procedures to protect against malpractice suits, Laube says.

Bonnie Jellen, head of the American Hospital Association's maternal and child health section, hadn't seen the report. She says women's preferences and doctor's malpractice concerns have helped raise the C-section rate.

Says Corry: "A lot of people think pregnant women are accidents waiting to happen. It's just crazy."