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Recognition for the Lamaze Push for Your Baby Campaign

March 20th, 2013 by avatar

PR News announced this week that Lamaze’s Push for Your Baby campaign was a co-winner for the 2013 Nonprofit PR Award for Digital PR and Marketing.

The Push for Your Baby campaign worked to provide expecting mothers with key information they needed to push for a safe and healthy birth for their baby. According to PR News, “the campaign launch successfully positioned Lamaze as a go-to resource for maternity care information and generated excitement among its educators.”

Within a week of launch, the campaign’s online video received over 1,000 views, and overall the campaign yielded more than 18 million earned media impressions. To date, the video has had over 8,400 views. Lamaze would like to thank Jones Public Affairs for their work on this campaign and leading the implementation.

Science & Sensibility first wrote about the “Push for Your Baby” in the blog post: New Lamaze Campaign: Push for Your Baby! Childbirth Educators Play a Key Role.

Are you using this wonderful video and accompanying materials to reach your students with the message that parents can push for a safe and healthy birth?  What has been the feedback from your classes on this material?  If you are not using it, won’t you consider incorporating this fantastic resource in your class curriculum?

You can read more about this award from PR News.

 

Awards, Babies, Childbirth Education, Evidence Based Medicine, Healthcare Reform, Healthy Birth Practices, Healthy Care Practices, informed Consent, Lamaze International, Lamaze News, Maternal Quality Improvement, Maternity Care, Newborns, Push for Your Baby , , , , ,

Maternity Care On the National Agenda – New Opportunities for Educators and Advocates

January 17th, 2013 by avatar

Today, Amy Romano, CNM, MSN, Associate Director of Programs for Childbirth Connection (and former Community Manager for this blog) follows up last Thursday’s post, Have You Made the Connection with Childbirth Connection? Three Reports You Don’t Want to Miss with her professional suggestions for educators and advocates to consider using the data and information contained in these reports and offering your students, clients and patients the consumer materials that accompany them.- Sharon Muza, Community Manager.

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As we begin 2013, it is clear from my vantage point at the Transforming Maternity Care Partnership that the transformation is underway. In Childbirth Connection’s nearly century-long history, we’ve never seen so much political will from leaders, so much passion from grassroots advocates, and so much collaboration among clinicians and other stakeholders. This new landscape presents many new opportunities for educators and advocates.

One area of maternity care that has garnered increasing attention is the overuse of cesarean section, especially in low-risk women. Last year, the multi-stakeholder Maternity Action Team at the National Priorities Partnership set goals for the U.S. health care system and identified promising strategies to reach these goals. One of the goals was to reduce the cesarean section rate in low-risk women to 15% or less. This work served as the impetus for Childbirth Connection to revisit and update our Cesarean Alert Initiative. We undertook a best evidence review to compare outcomes of cesarean delivery with those of vaginal birth. Based on the results, we also updated and redesigned our consumer booklet, What Every Pregnant Woman Needs to Know About Cesarean Section. These are powerful new tools to help educators and advocates push for safer care, support shared decision making, and inform and empower women.

Two of the biggest obstacles to change have been persistent liability concerns and the current payment system that rewards care that is fragmented and procedure-intensive. Efforts to make maternity care more evidence-based or woman-centered often run up against policies and attitudes rooted in fear of lawsuits or increasing malpractice premiums, or against the reality that clinicians can not get easily reimbursed for doing the right thing. But these barriers are shifting, 

Recently the literature has provided example after example of programs that reduced harm and saw rapid and dramatic drops in liability costs as a result. That’s right – one of the best ways to decrease liability costs is to provide safer care. Rigorous quality and safety programs are the most effective prevention strategy among the ten substantive solutions identified in Childbirth Connections new report, Maternity Care and Liability. The report pulls together the best available evidence and holds potential liability solutions up to a framework that addresses the diverse aims of a high-functioning liability system that serves childbearing women and newborns, maternity care clinicians, and payers.  

The evidence and analysis show that some of the most widely advocated reforms do not stand up to the framework, while quality improvement programs, shared decision making, and medication safety programs, among other interventions, all have potential to be win-win-win solutions for women and newborns, clinicians, and payers. If we are to find our way out of the intractable situation where liability concerns block progress, we must learn to effectively advocate for such win-win-win solutions.  Advocates and educators can better understand these solutions by accessing the 10 fact sheets and other related resources on our Maternity Care and Liability page.

Evidence also shows that improving the quality of care reduces costs to payers. As payment reforms roll out, there will be many more opportunities to realize these cost savings. To predict potential cost savings, however, it is necessary to know how much payers are currently paying for maternity care. Surprising, this information has been largely unavailable, and as a result we have had to settle for using facility charges as a proxy. This is a poor proxy because payers negotiate large discounts, and because charges data do not capture professional fees, lab and ultrasound costs, and other services. Childbirth Connection, along with our partners at Catalyst for Payment Reform and the Center for Healthcare Quality and Payment Reform, recently commissioned the most comprehensive available analysis of maternity care costs. The report, The Cost of Having a Baby in the United States shows wide variation across states, high costs for cesarean deliveries, and rapid growth in costs in the last decade. It also shows the sky-high costs uninsured women must pay – costs that can easily bankrupt a growing family. Even insured women face significant out-of-pocket costs that have increased nearly four-fold over six years. Fortunately, health care reform legislation has made out-of-pocket costs for maternity care more transparent by requiring a simple cost sample to each person choosing an individual or employer-sponsored health plan.

Educators and advocates have to be able to help women be savvy consumers of health care. That means being informed about their options and also being able to identify and work around barriers to high quality, safe, affordable care. Childbirth Connection produced this trio of reports to provide a well of data and analysis to help all stakeholders work toward a high-quality, high-value maternity care system.

How Childbirth Educators and Consumer Advocates Can Help

 What is the first thing that you are going to do to join this maternity care transformation? Can you share your ideas for using this information in your classroom or with clients or patients.  Can you bring others on board to help with this much needed transformation?- SM

Childbirth Education, Evidence Based Medicine, Guest Posts, Healthcare Reform, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Research, Research for Advocacy, Transforming Maternity Care , , , , , , , , , ,

Happy 20th Anniversary to the Cochrane Collaboration!

January 15th, 2013 by avatar

As I wrote about in my January 3rd, 2012 post on the top 10 reasons to join Lamaze International, one of the great benefits of being a Lamaze member is complete access to the Cochrane Collaboration.  The Cochrane Collaboration is an international organization whose purpose is to make available information on the effects of healthcare interventions.  Reports in the form of Cochrane Reviews are current, accurate and made available electronically on the internet and by DVD, and updated monthly.  Systematic reviews are conducted and published on a wide variety of healthcare interventions so that people can make informed decisions. This is stored in the Cochrane Library.

Archie Cochrane, photo credit: Cardiff University. Library, Cochrane Archive, University. Hospital Llandough

The Cochrane Collaboration was founded by Archie Cochrane, who was a British medical researcher.  Mr. Cochrane is best known for his article Effectiveness and Efficiency: Random Reflections on Health Services written in 1972.  

The creation of a systematic review of randomised controlled trials (RCT’s) of care during pregnancy and childbirth is “a real milestone in the history of randomised trials and in the evaluation of care.” Professor Archibald Leman Cochrane, CBE FRCP FFCM, (1909 – 1988)

The Cochrane Collaboration is celebrating their 20th anniversary this year, 2013 and will be sharing a series of 24 short videos over the course of the anniversary year, focusing on the ideas, achievements and people that have been part of the history of this international and well-respected organization.  I am sharing the first in this series, so you can learn a bit more about how this organization came to be recognized as the gold standard in evidence-based health care.

The United States Cochrane Center has created and made available free of charge, an online tutorial, “Understanding Evidence-based Healthcare: A Foundation for Action, that can help you to learn how to best navigate and understand the resources contained in the Cochrane Library.

Lamaze International’s Healthy Birth Practice Tools is completely based on evidence based information and was created so that consumers could understand and advocate for the best care for themselves and their babies.  Lamaze recognizes the importance of educators and others having access to up to date information and therefore is pleased to offer access to the Cochrane Library as a member benefit.   To access the Cochrane Library as a Lamaze member, first login to Lamaze International’s Member Center and then follow the drop down box to the Cochrane Library. You will be redirected to the library, with full access.

I rely on and use this member benefit constantly, and appreciate it being made available to me by Lamaze.  Won’t you share in the comments section how you use the Cochrane Library?  How has it helped you?  Do you find what you need?  Do you share information and studies with your students, clients and patients?  Let us know, please.

References 

Cochrane AL. Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972. (Reprinted in 1989 in association with the BMJ, Reprinted in 1999 for Nuffield Trust by the Royal Society of Medicine Press, London (ISBN 1-85315-394-X)

Childbirth Education, Continuing Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, informed Consent, Lamaze International, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research, Practice Guidelines, Research, Systematic Review , , , , , , , , ,

Have You Made The Connection with Childbirth Connection? Three Reports You Don’t Want To Miss

January 10th, 2013 by avatar

 

The past few weeks have been big ones for 95 year old, New York based Childbirth Connection.  Since I started working in the birth world, I have always appreciated the information and publications from Childbirth Connection, not only to advance my own professional knowledge, but as a reliable, evidence based resource for my clients and students as well as the doula and CBE trainees that I work with.  Today on Science & Sensibility, I would like to share the three new Childbirth Connection reports that you may find useful.

1. Vaginal or Cesarean Birth: What Is at Stake for Women and Babies?

Maternity care stakeholders (consumers, health care professionals, insurers, state Medicaid agencies and others) are increasingly concerned about the immediate, short-term and long-term impact that the country’s high cesarean delivery rate is having on mothers and children.  A Maternity Action Team was convened by a collaboration of national organizations. The purpose of this team was to address unsafe or inappropriate maternity care.  The team’s overall goal of reducing the cesarean rate in low-risk women to 15% or less.

The report created by Childbirth Connection focuses on the adverse consequences of cesarean birth on both women and children.  Included in the report is also information on potential adverse outcomes of labor and vaginal delivery.  The following questions are answered:

  • What physical effects may occur in women more frequently with
  • cesarean delivery?
  • What physical effects may occur in babies more frequently with cesarean delivery?
  • What role may cesarean delivery play in the development of childhood chronic disease?
  • What complications are unique to cesarean delivery?
  • What complications are unique to vaginal birth?
  • What are potential psychosocial consequences of cesareans?
  • What are potential effects of cesareans on women in future
  • pregnancies and births?
  • What are potential effects of a scarred uterus on future babies?
  • Does cesarean delivery protect against sexual, bowel, urinary, or
  • pelvic floor dysfunction?
  • Does cesarean delivery protect against injuries to babies?

The results of the evidence reviewed allowed the following conclusion to be reached the authors:

The findings of this report overwhelmingly support striving for vaginal birth in general and spontaneous vaginal birth in particular in the absence of a compelling reason to do otherwise. To improve both the quality and value of maternity care in the United States and promote the optimal health of women and infants, clinicians, policy makers, and other stakeholders should prioritize identifying and promulgating practices that promote safe, spontaneous vaginal birth and reduce the use of cesarean delivery.

2. The Cost of Having a Baby in the United States

Childbirth Connection in collaboration with Catalyst for Payment Reform and the Center for Healthcare Quality and Payment Reform recently released a report on the financial impact our current maternity care system has on both private payers and government funded care.  Maureen Corry, Childbirth Connection Executive Director shared that if the US were able to reduce the cesarean rate down to 15%, (from the current 33%), national spending on maternity care would go down by $5 billion dollars.

For the commercially insured, the average cost of a birth by c-section in 2010 was $27,866, compared to $18,329 for a vaginal birth. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births.  (The Cost of Having a Baby in the United States)

http://flic.kr/p/4vgkDo

There are facilities and providers who are effective at providing quality care and excellent outcomes while also demonstrating fiscal responsibility.  Yet other teams have costs that are drastically higher with outcomes that leave a lot of room for improvement.  What is the difference?  The report also noted that there were large variations in costs based on different geographic regions in the US.  Does the opportunity for practicing evidence based maternity medicine (resulting in a lower cesarean rate) provide the path for a reduction in maternity costs?  We learn in this report that “high-quality, high-value care” is an attainable goal and one that will benefit mothers and babies everywhere in our country.

3. Maternity Care and Liability: Pressing Problems, Substantive Solutions

If everyone is in agreement that the cesarean rate in the United States is too high, and that health care costs, including maternity care costs are skyrocketing, without an improvement in outcomes, then the next stop has to be examining the risks that health care providers and facilities assume and are held liable for when a less than optimum outcome occurs for mother or baby.  In the newest Childbirth Connection report released this week, Childbirth Connection takes a look at 25 different possible liability reforms and runs each scenario through the same filter, to find out which ones;

  • promote safe, high-quality maternity care that is consistent with best evidence and minimizes avoidable harm
  • minimize maternity professionals’ liability-associated fear and unhappiness
  • avoid incentives for defensive maternity practice
  • foster access to high-value liability insurance policies for all maternity caregivers without restriction or surcharge for care supported by best evidence
  • implement effective measures to address immediate concerns when women and newborns sustain injury, and provide rapid, fair, efficient compensation
  • assist families with responsibility for costly care of infants or women with long-term disabilities in a timely manner and with minimal legal expense
  • minimize the costs associated with the liability system
Which proposal will stand the test, and prove to be the solution that has the possibility of improving the situation for all involved, consumers, providers and insurers.  Are we headed down the right track with the changes that have been already implemented? It appears that we may be doing more harm then good in some cases.  Liability concerns may very well drive every decision a health care provider makes, and the proper system has to offer protection to both the consumer and the provider. This report identifies the factors that the appropriate reform needs that will allow for everyone involved to benefit.

Additionally, along with this fascinating report, is a set of 10 printable fact sheets that can be shared with health care administrators,  consumers and health care providers to facilitate understanding and discussion on the topic of liability reform.

Childbirth Connection Executive Director Recognized

Finally, I would like to share that Maureen P. Corry, MPH, the executive director of Childbirth Connection was recently named by Forbes Magazine as one of the “13 To Watch in 2013: The Unsung Heroes Changing Health Care Forever.”  Maureen is recognized as ”a strong policy advocate, but also a thoughtful and purposeful researcher who brings all sides together in very constructive ways, which is why many of the issues she has raised over the years are now on the top of the policy agenda in Washington.

The reports that Childbirth Connection has recently released clearly show that this organization, under the leadership of Maureen, is making significant and timely contributions to improving pregnancy and birth outcomes for mother and babies.  I am grateful for this organization, and would like to congratulate Maureen on behalf of myself, this blog and Lamaze International for a job well done!

Next week, Amy Romano, former Science & Sensibility community manager, and current Associate Director of Programs for Childbirth Connection will share how educators and advocates can use these reports in their classroom and with their clients and patients.  Have you taken the time to read any of the reports listed here today?  Are you already using them?  Please share your thoughts in our comments section.

Awards, Babies, Cesarean Birth, Evidence Based Medicine, Healthcare Reform, Maternal Quality Improvement, Maternity Care, Transforming Maternity Care , , , , , , , ,

Pelvic Exams Near Term: Benefit or Risk? Talking to Mothers About Informed Consent and Refusal

November 2nd, 2012 by avatar

Today, S&S contributor Jackie Levine discusses the potential risks of routine cervical checks near term and how to help your clients and students be prepared to have a discussion with their health care provider about the necessity of such exams. – SM

There are some studies that show a link between routine weekly pelvic exams in the last month or so of pregnancy and an increase in rupture of membranes (ROM) that occur well before labor was meant begin, meaning the membranes have ruptured prematurely, (adding a P to ROM, for premature rupture).   The natural onset of labor may be a week or perhaps only days away, but everything is not quite ready, and if effective labor does not begin induction frequently follows.  And when induction fails, as often it will, since the rupture was premature, and the body and the baby are not ready, cesarean is often the outcome.

photo credit: flickr (link below)

Many women find that their health care providers may start doing pelvic exams at about 37 weeks gestation.  Women should consider asking their doctor or midwife whether these exams are necessary to insure the health and safety of herself and her baby, before providing consent for this invasive procedure.  When I discuss these near term cervical exams with my childbirth class students and look at the studies, mothers-to-be have to ask themselves whether the benefits of weekly exams outweigh the other risks; potential PROM, induction and the increased possibility of cesarean section.

“How do I tell my health care provider that I don’t want an exam, and not have those uncomfortable moments when my doctor or midwife thinks I’m defying him or her and not letting them do what they always do?”  That’s the common and sensible worry, that our students may have, but if we provide an opportunity to role-play with our students and clients and also provide the studies, they will feel confident about having this discussion. They will know the facts and are informed health consumers who could consider saying “Oh, I just don’t want that exam today, so can we do it next week?” They might also share that they’ve researched this topic, mention the studies and ask how routine exams week after week will help insure good health.

An older study examining the relationship between late term pelvic exams and the incidence of PROM stated:

 In the 174 patients on whom pelvic examinations were done weekly starting at 37 weeks gestation, the incidence of PROM was 18%,   which was a significant increase (P=.001).  The primary cesarean section rate was comparable in both groups with PROM; however, the overall primary cesarean rate when PROM occurred was found to be twice that of the remaining population. The study suggests that routine pelvic examinations may be (sic) a significant contributing factor to the incidence of PROM. Women with uncomplicated pregnancies were randomly assigned to one of two groups. The author theorizes that the probing finger carries up and deposits on the cervix bacteria and acidic vaginal secretions capable of penetrating the mucous plug and causing sufficient low-grade inflammation or sub-clinical infection to rupture membranes.“  “It would therefore seem prudent to recommend that no pelvic examinations be done routinely in the third trimester unless a valid medical indication [sic] exists to examine the cervix … especially since the information gained from these routine examinations is often of little or no benefit to either the physician or the patient.” (Lenahan, 1984.)

We have all been subtly bullied at one time or another by those in positions of authority, and it’s easy to understand the courage and confidence needed to question a caregiver. It’s a mother’s right and responsibility first to know and then to question, but confidence is the key.  We must make an effort to give real meaning to a women’s right to choose, and to the principle of informed refusal.  The American Congress of Obstetrics and Gynecology (ACOG) has addressed informed refusal several times with its membership since at least 19921, speaking powerfully  about the autonomy of the individual.  Although these writings and bulletins are aimed mainly at assuring legal protection for caregivers, they are a resounding affirmation of the legal and moral right of the patient to decide for herself.

Since the studies assert that routine exams are neither predictive nor probative, the doctor or midwife must be able to say something medically strong to counter the available studies.  When mothers have asked their providers for the reasons to do an exam, they bring a myriad of interesting answers back to class for discussion, but rarely any facts or science.  Remember, ACOG  itself published a study last year examining the basis for its care guidelines and found that “One third of the recommendations put forth by the Congress in its practice bulletins are based on good and consistent scientific evidence” ACOG, 2011) meaning Level A, and that gives us pause to consider the 70% of practices represented by Levels B and C . Care providers will often reconsider when an informed mother-to-be can ask politely and tactfully, about the science that recommends a weekly routine cervical assessment.

Again, women should be able to weigh the risks of routine exams against the possibility of that cascade of interventions that follow on with PROM, interventions that will, at the least, lead to an uncomfortable and harder-to-manage induction, and at worst, put our students and clients on that gurney ride into the operating room.

When a mother is motivated to discuss routine pelvic exams with her caregiver, it may be the first test of the mutual trust and respect she hopes for in that relationship.  Until that point in her pregnancy, she may not have had the opportunity, or the necessity to assert her rights as a maternity patient.  She may have refused to have a routine sonogram or two because her insurance policy would not cover extra routine assessments, but refusing pelvic exams unless there is a valid medical reason will tell her how little or much her HCP is willing to act on best evidence, give her individuated care and show respect for her informed refusal.

The first time she refuses the exam may not be an accurate opportunity for her to judge; many caregivers will let refusal ride that once, but as pregnancy nears term, most docs begin to be insistent about cervical assessment, even without medical indication. A mother-to-be can begin to learn her caregiver’s view of best-evidence care and his or her willingness to listen to her so that she will have an idea, going forward, of how best to assert her rights, with knowledge and confidence in herself, and can get support she may need in our classes.

In a Science & Sensibility post in May 2011, I talked about the importance of giving mothers the same studies that caregivers have access to.  What I said then about giving our classes the actual studies, along with discussion, still applies:

“…perhaps we need to give women a different kind of “evidence”, by giving them a look into the medical community.  If women can know more of what goes on inside the profession, if they know a bit of what the docs know, they feel a different level of empowerment.  They feel a gravitas….Not only do they know that the evidence exists somewhere out there…they see it; they own copies of the studies. They feel trusted with special information that they would never otherwise have access to. In addition to learning to trust their bodies, in addition to knowing how birth works, in addition to practicing comfort measures, they learn about what goes on behind the scenes.  It expands their sense of control and choice. “  

Refusing to have routine pelvic exams in those last weeks of pregnancy is a real opportunity for our students and clients to learn how to ask for, even insist on, best-evidence care for themselves and their babies.  It’s certainly worth a try, and we can support them in the last weeks in a positive way with lots of opportunity for role-play and discussion as they report back to class and share their experiences with informed refusal.

How do you bring up the topic of regular cervical exams for women who are not in labor?  Do you talk about this with your clients and students?  What are your favorite resources for presenting this and facilitating discussions?  Have your students shared stories about their experiences.?  Are you a health care provider?  What are your feelings on routine pelvic exams at the end of pregnancy?  Share your thoughts in our comment section. – SM

References:

ACOG: Ethical dimensions of informed consent: a compendium of selected publications, ACOG Committee Opinion 108. Washington DC, 1992.

ACOG Committee opinion. Informed refusal. Number 166, December 1995. Committee on Professional Liability. American College of Obstetricians and Gynecologists. et al. Int J Gynaecol Obstet. (1996).

ACOG Committee Opinion No. 306. Informed refusal. ACOG Committee on Professional Liability, Obstet Gynecol. 2004 Dec;104(6):1465-6.

Lenahan, JP Jr., Relationship of antepartum pelvic examinations to premature rupture of the membranes. Journal Obstetrics Gynecology 1984, Jan:63(1):33-37.

Levine, J. (May 31, 2011) A Lamaze Story. Retrieved from http://www.scienceandsensibility.org/?p=2954

Vayssière, C. Contre le toucher vaginal systématique en obstétrique Gynécologie Obstétrique & Fertilité, 2005, Volume 33, Issue 1, Pages 69-74.

Wright JD, Pawar N, Gonzalez JS, Lewin SN, Burke WM, Simpson LL, Charles AS, D’Alton ME, Herzog TJ, Scientific Evidence Underlying the American College of Obstetricians and Gynecologists’ Practice Bulletins, Obstet Gynecol. 2011 Sep;118(3):505-12.

photo credit: www.flickr.com/photos/nathansnostalgia/498100786/

Cesarean Birth, Childbirth Education, Do No Harm, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternity Care, Medical Interventions, Push for Your Baby, Uncategorized , , , , , , , , ,