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.

 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

Amy Romano Childbirth Education, Evidence Based Medicine, Guest Posts, Healthcare Reform, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Research, Research for Advocacy, Transforming Maternity Care Amy Romano, cesarean, cesarean section, Childbirth Connection, Childbirth Education, guest post, interventions, maternity care quality, maternity care systems, research, Transforming Maternity Care

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.

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

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.

Sharon Muza Awards, Babies, Cesarean Birth, Evidence Based Medicine, Healthcare Reform, Maternal Quality Improvement, Maternity Care, Transforming Maternity Care Catalyst for Payment Reform, Center for Healthcare Quality and Payment Reform, cesareans, Childbirth Connection, liability, maternity care systems, maternity costs, Maureen Corry, Transforming Maternity Care

An invitation from Linda Harmon, Lamaze International’s Executive Director.  Please consider joining this interactive webinar and learn how you can help women “Push for Their Baby!” I know I am going to be online and participating!  Won’t you join me! – SM

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You play an important role in helping pregnant women achieve the safest, healthiest birth possible. Throughout pregnancy and birth, women need strong partners so they can get the maternity care that meets their unique needs.

Lamaze’s Push for Your Baby effort is aimed at helping women work in partnership with their care providers to achieve the best outcomes. And, we know there’s much work to be done. Certain birth practices, such as the overuse of cesarean surgery, early induction and confinement to bed can make it harder for women to have a safe and healthy birth.

As part of our initiative, we’re pleased to invite you to join an upcoming educational webinar for nurses and childbirth educators, which will offer one nursing contact hour and one Lamaze contact hour (with the purchase of a post-webinar quiz).

Push for Your Baby Nurse & Educator Webinar
Arming Women with the Tools to Push for the Safest, Healthiest Birth Possible
Friday, November 30, 2012
1:00 – 2:00 p.m. ET

During this webinar, we’ll discuss evidence-based research in maternity care, and introduce the latest tools to help nurses and educators support moms-to-be in navigating maternity care decisions. We’re excited to take this opportunity to support your important role in helping women recognize the challenges in maternity care and encourage them to speak up and push for better care for themselves and their babies.

Featured speakers include:  

• Tara Owens Shuler, M.Ed., CD (DONA), LCCE, FACCE, Lamaze President and Director of Continuing Education, Special Projects, & Lamaze Childbirth Educator Program, Duke AHEC Program
• Amy Romano, CNM, MSN, Co-Author, Optimal Care in Childbirth: The Case for a Physiologic Approach
• Jessica Deeb, RN, LCCE, and new mom

At the conclusion of the presentation, we will open up for a discussion and brainstorming session where we encourage you to share the real challenges you face in helping women get the best maternity care. Our mutual work is important to the health of women and babies, and we look forward to engaging with you on this initiative.

We hope you will join us for this exciting event! Register online to attend.

Best,

Linda Harmon
Executive Director/CEO
Lamaze International

P.S. Stay tuned for additional webinars in 2013 on hot topics and controversies in maternity care.

Sharon Muza Babies, Christy Turlington Burns, Continuing Education, Healthy Birth Practices, Healthy Care Practices, Lamaze International, Lamaze News, Maternal Quality Improvement, Push for Your Baby, Webinars Continuing Education, Healthy Birth Practices, Lamaze International, Lamaze webinars, LCCE, Linda Harmon, Sharon Muza, Transforming Maternity Care, Webinars

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

Amy Romano Films about Childbirth, Films about Pregnancy, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Transforming Maternity Care, Uncategorized Amy Romano, Blueprint for Action, Childbirth Connection, how do I get good maternity care, Join the Transformation, maternity care, Transforming Maternity Care

[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, Ohio, Washington, 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?

Amy Romano Maternal Quality Improvement, Midwifery, Patient Advocacy, Transforming Maternity Care Amy Romano, Childbirth Connection, Foundation for Informed Medical Decision Making, maternity care trends, medical home model, Midwifery, Transforming Maternity Care