Managed care changing obstetrics practices: about the only thing that hasn't changed is the first step in the birthing process. (Health Care Monthly)

Birthing babies is a changing business.

In a health care environment where the cost for any service is fair game for reduction, managed care has altered almost every step in the pregnancy process - except for the obvious.

To sell health care policies, managed care companies offer patients coverage for obstetrics services. To get managed care contracts and their steady flow of patients, hospitals have spent millions creating obstetrics departments. And to keep up with managed care companies' lower fees, both obstetricians and hospitals have to serve more patients to make ends meet.

So far, the results of all this maneuvering include less expensive obstetrics care, more hospitals offering obstetric services, less hospital time for patients, less patient time with obstetricians and more time with nurse-midwives.

And in the not too distant future, women may be able to see their obstetrician or gynecologist as they would their family or primary care doctor.

"I have opened my practice to lots of managed care programs. I can't risk losing patients because I am not on their health plans," said Dr. Elihu M. …