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How to Get Good Maternity Care

December 20th, 2011 by avatar

As someone who is knowledgeable about pregnancy and birth, I often hear from far-flung friends and relatives who have questions. The questions run the gamut: “Can I take this medication?,” “Do I really need to be induced?,” “What does this test result mean?” But I hear in these questions a much more basic question: “How do I get good maternity care?”

Whether each woman can articulate it or not, all women want maternity care that is woman-centered, safe, effective, timely, efficient, and equitable. These are the domains of high-quality care.

So how can a woman get high quality maternity care? As part of our Join the Transformation Campaign, Childbirth Connection created a new resource to answer this question.

 

 

 

(You can download a PDF handout of these tips here.)

These ten tips give women the foundation they need to begin to engage as savvy consumers of high-quality care, but there’s so much more work to be done to retool our system to fully enable this kind of engagement. How can women choose their caregiver and setting wisely without transparent performance data to evaluate quality? How can women understand the evidence without access to high-quality decision support tools that are appropriate for their literacy and numeracy levels? How can women control their health records if they can’t even access them electronically?

We launched our Join the Transformation campaign to strengthen our work to address these gaps. We’re working with partners to implement key recommendations from our consensus Blueprint for Action, so in the future when women ask “How Can I Get Good Maternity Care?” the answer is clear and the resources are at their fingertips.

 

Maternity Care With a Heart from Childbirth Connection on Vimeo.

 

 

Posted by:  Amy Romano, MSN, CNM

Films about Childbirth, Films about Pregnancy, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Transforming Maternity Care, Uncategorized , , , , , ,

The Homebirth Summit: Providing Much-Needed Multi-Stakeholder Collaboration

November 15th, 2011 by avatar

With the recent Homebirth Summit that took place in Warrenton, VA October 20-22, our country has witnessed increased attention on the state and incidence of this birthing option in the United States.  The Summit organizers have published the outcomes of the event, including Consensus Statements which can be viewed here.  Additionally, you can read comments about the Summit from attendees on various blog sites like Rixa Freeze’s Stand and Deliver, pediatrician Mark Sloan’s blog site (part one and part two) and Childbirth Connection’s Transforming Maternity Care blog site—written by former S&S editor, Amy Romano.

When flipping through the fall issue of the peer-reviewed journal Birth, I landed on the study, United States Home Births Increase 20 percent from 2004 to 2008 (MacDorman, Declerq and Mathews, 2011).  This 20 percent increase isn’t really surprising to me—there is so much momentum in the taking back childbirth renaissance.  The opening paragraph of the article reminds us how much birth location has changed over the past ~ 100 years:

 

Major changes in United States childbearing patterns have occurred over the past century. At the beginning of the last century, almost all United States births took place outside a hospital, the vast majority at home. However, by 1940, only 44 percent of births occurred outside a hospital, and by 1969 this percentage had declined to about 1 percent, where it has remained relatively stable for several decades.”

 

When looking at the Trends by State section of the article, I was interested to find the state in which I live, Montana, boasts the highest homebirth rate (2.18%).  That’s compared to the country’s over-all current homebirth rate of 0.67% in 2008 (most recent data).  While this trend feels significant (especially to homebirth advocates here in the Big Sky state) philosophical dichotomies still exist.

As a part of an email conversation I had with a friend the other day, I was yet again reminded of the age-old  riff between hospital-based and home-based birth providers or, more accurately, the cracks birthing women fall into when attempting to traverse the chasm between these two models of care.

This friend of mine, a doula whose family recently relocated to a very small northeastern Montana town, is pregnant with her second child.  Her first birth was successfully attended by a midwife at a birthing center in the town from which they recently moved.  Desiring the same level of skilled, attentive, compassionate maternity care, my friend began her search for a midwife who would look after her throughout her current pregnancy, labor, delivery and postpartum care.  And yet, due to their rather remote location, she found a lack of midwifery care in her exact locale.  Hoping to piece together her prenatal care from readily available care providers (a local obstetrics clinic) and the philosophical maternity care she truly desires, she hoped to attend regular prenatal care appointments with an OB who was willing to co-supervise the pregnancy with a more distant midwife.  We’re talking true, interdisciplinary collaboration, here.  However, when the OB clinic got wind of this plan, they flat-out refused to work in conjunction with a midwife, or to provide my friend with prenatal care if she chose to also work with a midwife.  So, for now, my friend is tending to her own prenatal care, punctuated with telephone calls and intermittent visits with the midwife she has hired (who lives 270 miles away).

If this story is at all reflective of the state of maternity care collaboration in our country, then the multi-stakeholder conversations that took place at the Homebirth Summit are more important than ever.

 

What are your thoughts on the Homebirth Summit?

 

 

Posted by:  Kimmelin Hull, PA, LCCE, FACCE

 

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Reasonable Choices for Bringing Back VBAC

September 27th, 2011 by avatar

[Editor's note:  This article by Amy Romano was originally posted on Childbirth Connection's Transforming Maternity Care site, September 12, 2011 and is re-purposed with permission.]

 

When I recently updated Childbirth Connection’s VBAC or Repeat C-Section Topic to reflect the findings of a government-sponsored systematic review and national consensus recommendations, I was struck by how few of the facts have changed in the years since the government’s previous VBAC evidence report. While there are more data than before, we already knew that the risks of uterine rupture in labor were about 1 in 200, that accumulating cesareans sharply increases the likelihood of life-threatening complications in future pregnancies, and that there are few situations when planned VBAC is objectively unreasonable. Although the evidence has not abated the precipitous drop in VBACs, perhaps unprecedented national consensus about the importance of prioritizing VBAC services, an increasingly savvy grassroots movement, and urgent calls from obstetric leaders will begin to move the needle.

As we shift the conversation from whether to do VBACs to how to enable more of them, focus on quality and safety in the context of VBAC is long overdue. According to new government statistics (pdf), one in five of the more than 4 million births each year in the United States occur to women who have previously given birth by cesarean. If evidence supports VBAC as a “reasonable option” for most of this population – and indeed the better option for many – it is time to be reasonable about how to make VBAC as safe, accessible, and satisfying as it can possibly be.

In the absence of nationally endorsed quality measures for VBAC, payment reform to provide better incentives to offer and achieve VBAC, and care coordination to help pregnant women navigate the health care system (all urgently needed), we turn to the broader concept of maternity care quality to offer a framework for high-quality VBAC care. We’re interested in hearing what VBAC quality improvement projects exist in your community, and are eager to feature them in our TMC Directory.

A QUALITY FRAMEWORK FOR VBAC

1. Help more women make and implement choices that are informed by the best quality evidence and aligned with their own values and preferences.

Rationale: While much attention has been given to ACOG’s “Level C” recommendation to undertake planned VBAC “in facilities with staff immediately available to provide emergency care,” this recommendation is superseded by their “Level A” recommendation to “counsel women about VBAC and offer [trial of labor]” to appropriate VBAC candidates. In addition, “decision quality,” i.e., the extent to which choices align with a woman’s stated preferences and values and available evidence, is a marker of overall health care quality. Not to mention, honoring people’s informed choices is the legal and ethical standard, acknowledged by all major health care bodies.

Current approach: Few women have a choice at all. According to the VBAC Policy Database, a voluntary monitoring project by the International Cesarean Awareness Network, half of U.S. hospitals either ban VBAC outright or have no providers willing to attend VBACs. In our most recent national Listening to Mothers survey, more than half of women interested in a VBAC were denied the option, usually because of provider refusal or hospital policies. In areas where VBACs are “offered,” women must often meet eligibility criteria that are not supported by high-quality evidence. Informed consent processes typically solicit consent for VBAC but may not provide a special consent process for repeat cesareans, despite the fact that repeat cesareans pose different and in some cases much more serious risks than first cesareans.

Why this is inadequate: Both planned VBAC and planned repeat cesarean section are reasonable choices with important potential benefits and harms but the trade-offs are very different. The current approach, which ostensibly is intended to reduce the already low likelihood of avoidable perinatal death or injury and associated liability, has resulted in significant collateral damage: most notably an increased risk of maternal mortality and a growing prevalence of life-threatening complications for both mothers and babies in future pregnancies. We are also seeing troubling care patterns, including court-ordered repeat cesareans, women laboring in hospital parking lots so they can show up just in time to give birth and avoid the pressure for a cesarean, and a sharp increase in the number of women with prior cesareans choosing to give birth at home, sometimes with no skilled provider present at all. The Agency for Healthcare Research and Quality (AHRQ) team that conducted the 2010 systematic review on VBAC versus routine repeat cesarean referred to the VBAC access issues as “chilling,” an assessment with which we at Childbirth Connection agree.

Another approach: We urgently need evidence-based, field-tested shared decision making tools to communicate the research evidence and help women clarify their preferences and values. We have seen a commitment to this approach in Canada, the United Kingdom, and Australia, but thus far nothing in the U.S. (a situation we hope to change through our Shared Decision Making Maternity Initiative). Although decision support tools can help a woman select the best choice for her, system barriers including payment incentives, liability concerns, and clinician education must be addressed simultaneously to ensure that she can implement her choice. Assessing the potential for shared decision making tools and processes to reduce liability should be a research priority.

2. Maximize the proportion of women planning VBAC who experience uncomplicated vaginal births

Rationale: Morbidity in VBAC labors is concentrated in the subset of women who have unplanned repeat c-sections. These risks include infection, hemorrhage, blood clots and emotional distress. In addition, having a VBAC reduces risks in subsequent pregnancies and virtually ensures that future births will be vaginal, while having a repeat cesarean sharply increases risks in subsequent pregnancies and virtually ensures that future births will be surgical. Finally, repeat cesarean costs payers significantly more than VBAC and has significant downstream economic costs because of these effects in subsequent pregnancies.

Current approach: Clinicians and researchers seem to have responded by focusing on selecting the women most likely to have a vaginal birth. Several researchers have attempted to create prediction tools to select these women, and some clinicians and hospitals have imposed strict eligibility criteria for planned VBAC. Significantly less attention has been given to prenatal and intrapartum interventions and care processes that may enhance a woman’s likelihood of having a safe vaginal birth.

Why this is inadequate: Calculating the likelihood of vaginal birth can provide helpful information to women making an informed choice to plan a VBAC or repeat cesarean. However, even women with a lower-than-average likelihood of vaginal birth usually have a better than 50-50 chance. Moreover, some groups with lower likelihoods of vaginal birth, such as women with high BMI or multiple prior cesareans, also face significantly higher than average likelihood of harm if they end up with a cesarean. The AHRQ systematic review concluded that none of the available prediction tools adequately selected women for successful trial of labor.

Another approach: The AHRQ systematic review researchers emphasized the need to incorporate “non-medical factors” in prediction tools to enhance their usefulness. These factors, which include liability concerns, the nature and extent of informed decision-making, and provider and birth setting characteristics, appear to have a stronger effect on VBAC likelihood than factors intrinsic to the woman. In addition, research is urgently needed to identify labor care strategies to promote safe vaginal birth in women with prior cesareans, in particular the potential contribution of midwives and doulas. A randomized controlled trial examining the impact of doula care on VBAC labors is currently underway in Canada.

3. Provide the best possible response to obstetric emergencies including uterine rupture

Rationale: Uterine rupture occurs in about 4.7 per 1000 VBAC labors and is an obstetric emergency requiring prompt delivery. Although the outcome of uterine rupture is usually favorable for both infants and mothers, morbidity and mortality may be minimized if the team is prepared, communicates well, and responds quickly and in a coordinated fashion.

Current approach: The small chance of a sudden emergency with high risk of serious fetal and maternal harm resulted in ACOG’s recommendation that surgical and anesthesia staff should be “immediately available” for VBAC labors. Although in 2010 ACOG clarified that women should be able to make an informed choice for a VBAC despite this recommendation, or be referred to another facility, the response to the possibility of uterine rupture continues to favor simply prohibiting women from planning VBACs.

Why this is approach is inadequate: The singular focus on availability of a surgical team has created a situation where women in communities without these resources must consent to unwanted and potentially unneeded cesareans in order to access any maternity care at all. It also assumes that availability of surgical resources automatically translates into an optimal outcome, but unprepared or ineffective care teams may not be able to avert preventable poor outcomes despite being “available.” The AHRQ review researchers identified several other obstetric emergencies that occur with similar frequency as uterine rupture and result in similar likelihoods of serious harm but for which the obstetric community does not deem 24/7 cesarean capability to be necessary.  For these obstetric emergencies, rather than forbidding labor, hospitals have begun focusing on proven patient safety strategies like enhancing teamwork, implementing checklists, and conducting drills and simulations.

Another approach: As noted above, obstetric emergencies requiring prompt cesarean delivery can happen in any labor and in any birth setting. The emerging concept of “high reliability obstetrics” provides a framework for preventing adverse events and managing them in a consistent fashion when they occur despite prevention efforts. This requires a multi-disciplinary commitment to preparedness, teamwork, communication, and documentation. Various safety courses teach teamwork and management of emergencies in obstetrics. A systematic review of multi-disciplinary simulation training found that such programs improved knowledge, practical skills, communication, and team performance in acute obstetric situations and were associated with improved neonatal outcome.

BRINGING BACK VBAC

If VBAC is a reasonable option for most women, we need a reasonable approach to ensuring quality and safety in VBAC. Like maternity care generally, transforming VBAC care will take multi-stakeholder commitment to system reform. With so much inertia in the system, consumers and advocates must maintain a strong voice to push for positive change. Our newly updated VBAC or Repeat C-section Topic and the latest data on cesarean and VBAC trends are two resources to help women and their advocates. Our Action Center provides more ideas for engaging in maternity care transformation.

 

Posted by:  Amy Romano, CNM

 

Cesarean Birth, Research, Transforming Maternity Care, Vaginal Birth After Cesarean (VBAC) , , , ,

What Are We Doing Now? Some Updates from Your S&S Writing Crew…

September 8th, 2011 by avatar

As summer approaches its end, fall just around the corner, I find myself settling into a new schedule.  Children back in school and summer travels dispensed of, it’s time to get my nose back to the grindstone.  This will look a bit different for me this year.  Along with my work here at Science & Sensibility, I have begun my studies in the School of Public Health at the University of Minnesota where I am pursing my Masters of Public Health ~ Maternal & Child Health.  Before any of that gets well under way, I will attend Lamaze’s 2011 Annual Conference in Fort Worth, Texas next week where I will conduct a breakout session, Social Media for the Childbirth Educator:  Helpful or Hindrance?  Five hours after delivering this session, I will virtually (via pre-recorded video) be apart of a panel discussion at the Postpartum Support International conference in Seattle, WA , to discuss issues pertaining to postpartum mood disorders, childbirth educators and social media users—along with the other panelists, Penny Simkin,  Nancy Lantz, Emily Dossett, and Walker Karraa.

Having recently submitted a midwifery-geared textbook chapter to a publisher in the U.K., I expect to do some editorial work on that in the coming weeks/months.  And speaking of editing, I am enjoying do a little substantive editing on childbirth education video scripts for the primary childbirth ed. video production company in the U.S.

Apparently, I am not the only one with a bursting-at-the-seams schedule.  Here are some updates from a few of the other Science & Sensibility contributing writers to keep you up-to-date on the work we are doing to improve maternity care for moms and babies:

 

Jackie Levine, LCCE, FACCE, CD(DONA), CLC:  After a hiatus of 6 summertime weeks, Jacqueline (Jackie) Levine will be back at her local Planned Parenthood Center teaching Lamaze classes to the pregnant clientele and their families.  Remember, 97% of Planned Parenthood’s services are directed towards providing essential health care for women in the communities they serve. All women in her classes get free labor support and post partum breastfeeding support. She will teach her fall class on the history and policies of childbirth in America at CW Post as a guest lecturer, will teach breast feeding classes for DONA certification candidates,   resume the research-and-writing of RPFs for her doula group, the Long Island Doula Association, and will continue to be an enthusiastic contributor to and supporter of Science and Sensibility.

 

Penny Simkin, PT:  In the coming months, Penny Simkin will participate in several childbirth conferences, among them a 5-days trip to Iceland to give talks and trainings for childbirth professionals. She will also teach a full schedule of childbirth and sibling classes, and will attend the births of a few doula clients who are due in the next few months. She will be working with DONA International on revising the birth doula manual, and has a few other irons in the fire, including a new DVD for siblings-to-be.

Henci Goer: In August, Henci Goer turned in the manuscript (at last!) for a top-to-bottom new edition of Obstetric Myths Versus Research Realities, co-authored by Amy Romano, to its publisher, University of Michigan Press. The working title is Obstetric Myths Versus Research Realities: Optimal Practices and Obstacles to Implementation. She is not, however, resting on her laurels. She is planning on doing a new edition of Thinking Woman’s Guide to a Better Birth that will make use of the updated research gathered for the second edition of Ob Myths. She also will be updating her talks for her fall speaking engagements in Austin, TX; Burbank, CA; Niagara Falls, Ontario; and Moscow, Russia. (See http://hencigoer.com/talks/ for further info.) Now that the big push to get the manuscript done is over, Henci also looks forward to resuming writing blog posts for S&S. In addition, she will be doing a guest appearance on Lamaze’s Facebook page in October, and will, of course, continue with responding to questions and moderating her Lamaze forum, “Ask Henci.”

Edith Kernerman, IBCLC:  Well,  8 weeks to go before my biggest project is due:  crazy about babies, though—they don’t exactly come when you hope they will!   In my case, I am one of those unusual expectant mothers who hopes the little one will come a bit on the late side (my last 2 did!)—not so late that I have to deal with “the system” but late enough so I can finish all that I have to do before then!

So, what is all of that?  I have an e-book on the GamePlan for Protecting and Supporting Breastfeeding in the 24 hours of Life and Beyond (based on the booklet of the same name that has been out since 2006) that I have just finished and sent for editing—so, let’s hope my editor finds no fault and sends it back with no revisions…yeah…right…!  There’s a chapter I must start writing on how the healthcare system supports breastfeeding (or doesn’t), and this is due in October for a book coming out of Australia.  I have another chapter on Pain due for someone else’s book from North America.  I am presenting a talk at the Association of Perinatal Naturopathic Doctors in mid-October on Mammary Constriction Syndrome.  And we are just finishing the study design for the big study on Mammary Constriction Syndrome (following in the footsteps of our pilot study) that we are hoping to team up with a pediatric cardiologist who works with Doppler so we can measure changes in blood flow to the breasts while mothers are experiencing pain.  I am also co-teaching a 2-day workshop in mid-September on Beyond the 20 hour Course in the London, Ontario area.  I have also been working on the iphone app for the L-eat Latch and Transfer Tool, and the electronic charting version of the L-eat for Hospitals (quite late on that as I was asked for this 2 years ago!).    I think I am a couple of blogs behind for Science & Sensibility, I am 4 blogs behind for www.BabyLatch.com  and I have 2 due for www.BreastFeedingInc.ca  and another for www.nbci.ca .  All the above needs to get done before the end of October, while I am working every day in the clinic seeing moms and babes, overseeing IBLCE Pathway 3 students and NBC diploma students and Midwifery and med students on rotation, supervising clinical and administrative staff, and helping to get our 3 new wonderful docs comfortable before my mat leave—all at our International Breastfeeding Centre’s Newman Breastfeeding Clinic in Toronto.   Oh, and I forgot to mention that my book, Breastfeeding the Baby Who Does Not Latch is so behind deadline I can’t even think about it!

Amy Romano, MSN, CNM: I continue to work for Childbirth Connection as the Project Director for the Transforming Maternity Care Partnership. This fall I’ll be dedicating a lot of my time toward our shared decision making initiative, a collaboration with the Foundation for Informed Medical Decision Making. I’ll also continue to oversee the Transforming Maternity Care web site and blog, which offer tons of resources for maternity care quality improvement. 

This fall also marks two major writing milestones. On October 1, the 9th edition of Our Bodies, Ourselves will hit bookstores. I was one of the editors of this edition, responsible for the pregnancy, birth, and postpartum chapters as well as one chapter on navigating the health system. I’ll be attending a global symposium on women’s health and human rights in Boston, an event that will celebrate the 40th anniversary of the landmark book. In addition, Henci Goer and I have recently submitted the manuscript for Obstetric Myths vs. Research Realities (finally!) and I expect to be working through the editorial process on that book as well.  One of the events on my fall calendar that I’m most excited about is my local Nurse-Midwifery Week event which will feature several speakers including Science & Sensibility’s own Tricia Pil, discussing patient safety in maternity care. On a personal note, my “baby” starts kindergarten this fall and my daughter (who was born just a few weeks after I started working for Lamaze) starts 2nd grade!

Kathleen Kendall-Tackett, Ph.D., IBCLC:  Kathleen has a number of exciting projects that she will be working on  this Fall. She started a small publishing company focusing on women’s health in March, 2011 (www.PraeclarusPress.com). She currently has five books under contract and has already received one manuscript. Several others are due by the end of the year. Dr. Kendall-Tackett will also be working on the December issue of the journal, Clinical Lactation in her capacity as editor-in-chief. The upcoming issue has some great articles including an article on ergonomic principles to help prevent pain in breastfeeding mothers, another on breast massage and hand expression, and still another on breastfeeding folklore in American Indians. She will also be finishing her term as associate editor of the journal, Psychological Trauma.

Kathleen and her colleagues, Tom Hale and Zhen Cong, have been analyzing data from their Survey of Mothers’ Sleep and Fatigue. This latest set of analyses focuses on the impact of sexual assault on women’s sleep and depression risk postpartum. The sample includes 6410 women from 59 countries, including 994 women who have reported sexual assault. The first two papers from this study can be found at http://www.kathleenkendall-tackett.com/research-projects.html. And I’ll round out the year with a lot of conferences across the U.S. and the Laktation und Stillen conference in Berlin, and a breastfeeding conference sponsored by the Belgian government at the University of Ghent. It’s looking like a busy, but really interesting, fall.

Tricia Pil, MD:  In October, Tricia is looking forward to traveling to New Haven to speak at the annual Midwifery Week Celebration for the Connecticut nurse-midwives association, which is being hosted and organized by former S&S Community Manager and current Childbirth Connection associate program director Amy Romano. She also has a letter-to-the-editor forthcoming in the American Journal of Obstetrics and Gynecology that provides a critical analysis of an obstetrics patient safety program at a major academic medical center, and she will be sharing that with S&S readers as soon as it is published.

Christine Morton, PhD continues to work at CMQCC – where projects underway include ongoing data analysis of the CA-PAMR Pregnancy Associated Mortality Review.   CMQCC will focus its next toolkit on Preeclampsia/Eclampsia, which emerged as the second leading cause of death in the CA PAMR findings.She is also co-authoring a white paper on the rising Cesarean Delivery rate in California and identifies promising Quality Improvement Opportunities in the domains of clinical care and payment reform.   Christine is engaged in two collaborative research projects with social science colleagues–one is a study of traumatic childbearing experiences (interviews with women, their support persons and providers) and the other is a national survey to be released early next year to all labor & delivery nurses, childbirth educators and doulas about their attitudes and practices on routine interventions in childbirth.  She is also slowly making progress on her book manuscript on doula care based on her dissertation research.

 

 

 

 

 

 

 

 

 

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Four Maternity Care Trends to Watch

September 6th, 2011 by avatar

[Editor's note:  This post by Amy Romano is re-purposed here with permission, having  initially appeared on Childbirth Connection's Transforming Maternity Care blog site on Monday, August 15.]

 

There’s a big gap between our current maternity care system and the high-quality, high-value system envisioned by a multi-stakeholder Transforming Maternity Care Project Team. We’re glad to see many of the recommendations put forth in the Blueprint for Action garnering broader interest and gaining momentum. Here are four we expect to play a growing role in system transformation over the coming months and years.

Women- and Family-Centered Maternity Care Homes

Just about everyone agrees that the patient-centered medical home will transform primary care. But we’ve seen little attention to how best to provide this model of prevention-oriented, personalized, coordinated care to childbearing women and newborns.  Although we’re just beginning to see implementation, the woman- and family-centered maternity care home concept seems to be gaining ground. North Carolina’s Pregnancy Medical Home program provides incentives to Medicaid providers to better coordinate health and social services for pregnant women and provide evidence-based care to reduce preterm births and cesareans. We’ve also seen interest in this concept in Minnesota, although legislative hurdles remain. We expect to see more innovation in this area, especially as the economic crisis and Medicaid expansion force payers to focus on cost containment and value.

Midwives, birth centers, and home birth

Just in the past month, an obstetric leader called for increased use of midwives to help curb the rising cesarean rate, Illinois cleared a regulatory hurdle paving the way for 10 freestanding birth centers to open across the state, and several major news sources reported on the rise in planned home births. Given the major cost advantages for out-of-hospital births, decades of evidence showing safety and benefits of midwifery care, and multiple forces aligning to produce critical workforce shortages, we expect midwives, birth centers, and home birth to gain the same interest among payers and policy makers that they’ve long had among consumers.

Shared decision making

Shared decision making is another broader health care trend that we expect to see find its due place in maternity care. Health care leaders are looking to shared decision making to make care more patient-centered, improve safety, rein in unwarranted practice variation, and reduce costs. While SDM found its roots in primary care and surgical specialties, our own collaboration with the Foundation for Informed Medical Decision Making represents the first major commitment to expanding the tools and concepts of SDM to maternity care. Look for a new maternity SDM web site and a suite of decision aids in the next year.

Quality Collaboratives

Facilities, providers, payers, and other stakeholders are joining forces to assess, track, and improve quality and safety. While quality collaboratives are not new, maturing information technology systems and new quality measures are enabling and accelerating data-driven improvement. Whether its hospital systems like Hospital Corporation of America, Geisinger, or Intermountain; state collaboratives like those in California, OhioWashington, and Oklahoma, or national collaboratives like the IHI Perinatal Improvement Community, we’re seeing major momentum from these entities in tackling safety problems and disseminating and replicating best practices.

What maternity care trends are you watching?

Maternal Quality Improvement, Midwifery, Patient Advocacy, Transforming Maternity Care , , , , , ,