Barbara Bridgman Perkins, PhD, independent scholar, 1806 24th Ave NW, Olympia, WA 98502, (360) 570-8786, bbridgperk@aol.com

This paper examines the clinical impact of incorporating components of business into medical care. Specifically, it studies how business elements in U.S. perinatal care have shaped the use of technological and surgical procedures in birth and imposed barriers to the utilization of scientific evidence.

Hospital-based obstetrics historically applied an industrial-type of scientific management to birthing (and professional) labor, fragmenting birth into a series of tasks routinely performed by a hierarchy of personnel. The obstetrician arrived in the delivery room near the end of the process to cut an episiotomy and apply outlet forceps. Continuous electronic fetal monitoring and epidural analgesia subsequently converted the labor room into a kind of intensive care unit--itself a business form of medicine. Acceleration techniques like active management of labor comprised managerial methods from the Industrial Quality Management Sciences to schedule personnel and achieve predetermined standards of productivity. Elective cesarean section and labor induction also fit managerial methods of standardizing birth. These mechanisms of scientific and quality management shift interventional decision-making away from the practitioners most knowledgeable about the patients. Their procedural standardization becomes fixed in liability law as well as medical mentality.

The medical business does not deny scientific method; it redefines it. It replaces outcome studies with managerial process and defines science (and quality) in terms of economic productivity. The paper concludes that achieving evidence-based childbirth intervention will require transforming the business organization and procedures of perinatal care.

Learning Objectives: Participants in this session will be able to

• Identify four components of the business model of medical care
• Describe how business elements shape particular childbirth interventions
• Distinguish two interpretations of scientific method in clinical practice

Keywords: Alternative Perinatal Services, Perinatal Outcomes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.