Archive for the ‘Research for Advocacy’ Category

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.


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 , , , , , , , , , ,

New Lamaze Campaign: Push For Your Baby! Childbirth Educators Play A Key Role

May 22nd, 2012 by avatar

Lamaze International has released a new campaign, “Push for Your Baby!” that demonstrates the key role that childbirth educators have in providing the tools for mother and families to ask for and receive the best care possible for their pregnancy, labor and birth.

Along with the “Push for Your Baby” campaign, Lamaze International reveals two new websites, Lamaze International for Parents geared for parents and consumers seeking information about classes, best practices and resources to help them connect with a Lamaze Certified Childbirth Educator and have the best birth possible and Lamaze International for the childbirth professional, where you can find professional development opportunities, forums for peer connection, resources for working with families to help them have the safest and healthiest births possible and information on becoming a Lamaze Certified Childbirth Educator.

“With the right information and education, women have the opportunity to be active partners in their care during pregnancy and birth, not just recipients of that care,” said and Lamaze Childbirth Educator Program for the Duke AHEC Program. “This campaign is designed to help women be ‘savvy shoppers’ and prepared to seek out the best care for their babies and themselves.”Lamaze President-elect Tara Owens Shuler, MEd, CD(DONA), LCCE, FACCE, Director of Continuing Education, Special Projects

The key components of the “Push for Your Baby” campaign include;

  • Push for Better!

Women often do not know what questions to ask or how to find out if the recommendations and suggestions provided by care providers are in line with research about what is best for mothers and babies. Childbirth educators play a significant role in preparing parents to have the conversations that matter, when the parents have learned and understand what the current research says about healthy birth practices from attending your classes.

  • Spot the Best Care

Parents often receive an overabundance of information during the childbearing year on the topics of pregnancy, labor, birth, breastfeeding and newborn/infant care. Much of this information, though potentially well meaning, might not be totally accurate. Lamaze provides an easy way for parents to understand the practices that offer the safest care and explains their options and avoid unnecessary interventions. Directing your families to the Six Lamaze Healthy Birth Practices, complete with short videos and downloadable pdfs of research and resources helps simplify the information overload and provides accurate resources to help parents understand how to have the healthiest and safest birth possible.

  • Childbirth Challenges
As labor unfolds, being flexible and adapting to changing circumstances is an absolute necessity for women and their partners. Working in partnership with their care providers to understand interventions and the alternatives that might be available can help families to avoid unintended consequences. Your role as a childbirth educator is critical to giving mothers and partners the tools to face these challenges if they should arise during their labor and birth.

  • Questions to Ask Your Physician or Midwife

10 Questions to Ask When Selecting A Care Provider can help families to identify doctors and midwives who are a good fit for them and who practice in a way that feels good to the mother. Using these well thought out questions can help families decide who is the right person to help them welcome their baby in the safest and healthiest way possible. Women may not do the up front “leg work” to find a provider who shares their vision of pregnancy and birth, but these questions provide a great guide. Using these questions as resources in an early pregnancy class can help your students find the right fit for their pregnancy and birth.

Questions to Ask During Labor and Birth will help mothers and their partners to ask the important questions when faced with decisions during their labor and birth. The unpredictability of certain birth situations will require parents to gather information. These simple questions will help them to organize their thoughts and advocate for their birth and their baby. Taking time to collect this information will allow mothers to feel confident in the decisions they make as they work to birth their baby in the safest and healthiest manner possible.

Childbirth education can help you to push for the best care! In a poignant, and extremely effective eight minute video, meet seven women and hear more about their births, the challenges they faced, their experiences in seeking care that felt good to them and the choices they made. Hear how these women feel about their birth experience. The celebrations and the forks in the road. These stories are a wonderful cross section of the types of experiences that women in our classes may receive, all across the country and around the world. The message in the video is loud and clear that childbirth education helps women to be better positioned to ask the right questions, seek appropriate care and be more prepared to face the challenges that may arise during their labor and birth.

Take a look at this video, and think about how you can share these women’s stories with the women and families that you work with. What discussions can grow from the stories in the video?  How are you going to use this learning tool to help prepare the families that you work with to “Push for Your Baby” and receive the care they and their babies deserve? Share your ideas with us here in our comments section and let us know what YOU plan to do?

Lamaze educators around the world are the cornerstone of  good childbirth education preparation for today’s parents. The “Push for Your Baby” campaign recognizes the information that parents learn in your classes helps them to be better prepared, play an active role in advocating for themselves and their babies and asking for care that is backed by research and proven to be safest and healthest for mom and baby.

What you can you do today?

Explore both the Lamaze for Parents and Lamaze International for educators websites and see what is new and exciting

Watch and share the “Push for Your Baby- Parents Share Their Stories” video with your online community

Place the new “Push for Your Baby” Logo, Banner and Button on your blog or website to let the world know you support safe and healthy birth practices

Visit the Lamaze Science & Sensibility Facebook Page and share the “I Help Parents Push for the Best Care” picture to spread the word in your social community about this exciting new campaign and your role in helping parents to “Push for Your Baby.”

Watch the Science & Sensibility blog over the next days and weeks as we explore together all the rich resources available to you as educators on the new and improved websites.


Babies, Childbirth Education, Healthy Birth Practices, Healthy Care Practices, Lamaze News, Maternity Care, Medical Interventions, News about Pregnancy, Patient Advocacy, Practice Guidelines, Push for Your Baby, Research for Advocacy, Social Media, Transforming Maternity Care, Uncategorized , , , , , , , ,

New Research Project Looking at Lived Experiences of Pregnant Women in the Work Place

September 21st, 2011 by avatar

[Editor’s note: I was recently contacted by a PhD student at Texas Tech University who is working with a professor at the University of Georgia to research pregnant women’s experiences at work. The research team is seeking to understand how organizations can do a better job at helping pregnant women in the workplace (or at the very least, stop doing things that negatively impact them). They have created a brief, 15 minute survey that involves asking pregnant women how they manage their identity at work.  The research team is looking for ways to spread the news on this project–including using social media as a primary platform for survey distribution.  Will you, after reading the following statement, please consider passing this onto your students/clients/patients?  The more women who complete this survey, the better representation of thoughts, opinions and experiences there will be.  I’m sure all of us can think of one example in which we know a woman could have been better supported by her work environment during her pregnancy.  Won’t you help spread the word on this important research project?]


Are you pregnant and working? We need your help!

We are researchers from the University of Georgia and Texas Tech University, studying the attitudes and behaviors of pregnant working women. We are also mothers and understand the struggles pregnant working women feel. We want to help so we are studying ways to improve the workplace experiences of pregnant working women.  To do so, we need pregnant working women who are 18 years of age or older to fill out a short survey. The data obtained in this survey will help us develop a valid instrument so that in the future we may test these experiences and how they relate to organizational outcomes.

PLEASE CLICK THE LINK BELOW TO TAKE THE SURVEY. Also, please forward this link to other pregnant working women.


You can also click on the links below to learn a little more about the researchers,  You can then click through to the survey by clicking “PREGNANT AND WORKING SURVEY. CLICK HERE”.

Dr. Laura Little – http://www.terry.uga.edu/profiles/?person_id=768

Amanda Hinojosa – http://management.ba.ttu.edu/people/Amandacv.pdf


Posted by:  Kimmelin Hull, PA, LCCE, FACCE

New Research, Research, Research for Advocacy, Uncategorized , , , , , ,

Making Healthy Birth Go Viral: Why Birth Professionals Should Be On Social Media

July 26th, 2011 by avatar

“Young women these days may not need a book to get answers to their questions about pregnancy. After all, they have the Internet for that.” – NPRs Lynn Neary onWhat to Expect When Youre Expecting


Birth activists, professionals, practitioners: take note.  Women –of all ages and socio-economic levels—are turning to the Internet to answer their questions about pregnancy, birth and breastfeeding.

Widespread, meaningful influence of birth information available to women used to require a book deal, a publicist, a book tour, a NY Times bestseller.  Now all it requires is a laptop, an Internet connection and the savvy use of low-cost, easy-to-learn tools.

These tools are game changers for those of us who want to spread evidence-based information, influence birth policy, and build our business.


Social Media Helps Mothers Influence Birth Policy

Not sold yet? Hear how social media has organized mothers:

In New York State, homebirth access was at risk without the passage of new legislation.  The statewide midwifery advocacy group, the New York State Association of Licensed Midwives, hired a lobbyist and went to the capitol.  The legislators’ response?  We need to hear from moms, not midwives.  A small group of homebirth mothers in central New York got out their laptops and, working at night after day jobs and child rearing, organized thousands of moms into the homebirth advocacy group, Free Our Midwives.  All through one blog and Facebook and Twitter accounts—with a budget of less than $500—more than 14,000 mothers were educated and thousands were mobilized into quick action, including a last-minute effort that flooded the governor’s office with calls in less than an hour. ACOG came out strongly against the legislation, but social media effectively leveraged the power of a few women in upstate New York and gave them the ability to mobilize large groups of constituents through the sharing of a simple Facebook status update.  Freeourmidwives.org was honored by the statewide midwives for their key role in passage of the bill.


Social Media Helps Educate Mothers

Still not sure? Learn about how social media is educating mothers:

Increasingly, research is showing us that women are turning to the Internet to research health care questions.  According to one survey, nearly half say they research health questions on the Internet first before calling their own health care provider.

The amount of information about pregnancy and birth on the Internet is astounding – googling “pregnancy” delivers more than 300 million results.  Is all of the information credible, evidence-based, or empowering to women?  Surely not.

But don’t discount the sophistication of the 2.0 mom.  When searching for credible information on any topic, they are making complex choices about accuracy, source reliability, and compatibility with their personal goals and philosophies.  The same is true when seeking out health information—while one in three adults report they or someone they know have been helped by medical advice on the Internet, only three percent report any harm.

Not since the printing press has there been a similar revolution brought on by the amazing proliferation of information access.  It is no coincidence that the rapid access to health care information in all areas is happening in parallel with significant changes away from the top-down thinking of “doctor is always right” to a shared decision-making model.

So how do we counter inaccurate or disempowering information?  By increasing the spread of accurate information that we know will educate and empower women.  By learning the tools we need to make *our* web pages come to the top of Google.  By making healthy birth go viral.

This is critical—current research shows that, despite access to information, women are still, on the whole, not educated about birth.1  The recent Amnesty International report, Deadly Delivery—and our own common sense—tells us that educating women with evidence-based information will improve maternal and infant health outcomes.

The spread of smart phone technology means that Internet access is no longer confined to those with a nice computer and Wi-Fi.  Eighty-five percent of all Americans own a cell phone, and seven in ten send or receive text messages. Text4Baby, a program of the National Healthy Babies, Healthy Mothers Coalition where women receive evidence-based health care information via phone texts, was built on the premise that low-income women, most in need of good health care information, are best reached through mobile technology.


Social Media Helps Build Your Birth Business and Grow Your Organization

The effective spread of great information is a win-win situation. It not only helps women, it also helps you build your business.

Social media is not really just about the spread of information.  It is about engaging with your audience, not doing all the talking, but being a good listener.  Sound familiar?

The best social media practitioners are just like the best midwives, lactation consultants, and childbirth educators.  They listen to their audience, hear their needs, and deliver evidence-based information in the style best suited to the mother’s personality and learning preferences.  Social media was made for us!

Women are increasingly turning to the Internet, not only to find information and camaraderie with others experiencing a similar stage of life, but to find providers.  By being out there, spreading evidence-based, empowering information, you are also finding the women who are the best possible fit for your practice.

None of this means that you need to live your life at a screen.  Or that you need to launch the next leading birth blog to influence the information landscape.  With 15 minutes a day, you can maintain a social media presence that has the power to spread evidence-based information, influence maternal health policy and build your business.

The beauty of social media is that it is not one size fits all. You can customize a web presence that fits your speed, style and needs.

Not sure how to get started?  The good news is that you are not alone.  You can get involved in ways big and small. If you sit on the board of your local birth non-profit organization, or are a decision maker at a birth business, support efforts to engage with social media, even if you don’t plan to build your personal presence online.

Nearly every birth conference these days has a workshop on social media—attend it! Participate in webinars like the one recently sponsored by Lamaze and delivered by Science & Sensibility’s Kimmelin Hull, and Giving Birth With Confidence’s Cara Terreri. Together, we can provide women with what they most need – high quality, evidence-based information about birth.




1  Klein, M.C., et al. (2011). Birth technology and maternal roles in birth: knowledge and attitudes of Canadian women approaching childbirth for the first time. Journal of Obstetrics and Gynaecology Canada, 33, 59-608.




Authors’ biography:

Hillary Boucher and Jeanette McCulloch are birth activists and professionals
and co-moderators of #BirthGenius, a Twitter chat designed to build a community
of birth professionals working together to make healthy birth go viral.
Learn more at their new blog, www.birthswell.org.








Guest Posts, Midwifery, Research for Advocacy, Science & Sensibility , , , , , , , , , , ,

Positioning During Second Stage of Labor: Dorsal Lithotomy vs. Lateral Lying

March 24th, 2011 by avatar

The final post in this blog series will examine the pros and cons of assuming a lateral lying position during the second stage of labor as compared to dorsal lithotomy position. Anatomical implications, perineal outcomes, and orthopedic concerns will all be addressed.

Anatomical implications
As discussed in earlier posts, dorsal lithotomy puts the birth canal in an “uphill” orientation. Conversely, the lateral lying position places the birth canal in a gravity-eliminated orientation, allowing the laboring mother to have a mechanical advantage during the pushing stage.  Also, when in side lying on the left side, there is optimal blood flow as compression of the inferior vena cava by the uterus is avoided.

Perineal outcomes

Shorten (2002) compared birth positions, Accoucher, and perineal outcomes in almost 2900 births.  It was found that the lateral lying position produced quite favorable results with regards to the health of the perineum.  Below average rates of episiotomy were observed and intact perineums were seen in 66.6% of the women who delivered while lying on their side.  The lateral lying position was, by far, the best choice for decreasing the risk for tears and the need for sutures in their research.

In a study by Soong (2005), the need for perineal sutures was decreased when a lateral lying position was assumed during delivery with epidural anesthesia.  The semi-recumbent position was associated with an increased need for suturing.  If a woman does choose to receive an epidural during her labor, it is important to realize that there are a fewer number of possible positions that she can assume because of the effects of the anesthesia.  However, given the aforementioned study by Soong, a woman should be able to make an informed decision about what position may be the best choice to improve perineal outcomes.


Orthopedic concerns
Although the lateral lying position does not have as many advantages as, for example, squatting or quadruped during a “normal” birth, it does have many indications when looking at births that involve a mother with orthopedic issues present.  One example is when a woman is suffering from coccygeal (tailbone)pain. Lateral lying may be the best choice for her to be in as this position does not place any force on this area and also allows the coccyx to move freely and out of the way as the baby descends.  Furthermore, it may be helpful to the woman who has pubic symphysis dysfunction, if careful attention is given to not overly abduct the lower extremities, placing undue stretch to the already separated joint.

In consideration of the spine, the side lying position is beneficial to keep the lumbar spine in a flexed position when spondylolisthesis or spinal stenosis are present.  The amount of flexion may be easily adjusted to maintain or improve maternal comfort during second stage and may improve her ability to recruit the proper musculature to push, if pain due to spine impairments is decreased.

Lastly, the lateral lying position may be optimal if hip joint dysfunction, knee joint dysfunction or superficial/deep vein thrombosis (while lying on unaffected side) is present (Hobel 2004).  Once again, attention must be paid to avoid end ranges of motion to decrease strain on the hip and knee joints and decrease risk for further injury. (See previous posts in this series for further discussion on the above-mentioned orthopedic conditions)


I have covered many advantages and disadvantages over the last three posts when considering second stage labor positions.  It is important to note that further research is needed in this area so we may better understand the implications of each position.  Likewise, additional information will further support  our education of women on optimal second stage positioning.  There are many different individual concerns of every woman, in every circumstance, in every birth.  It is my hope that women everywhere will be empowered to make an informed decision according to what birth outcome is important and specific to them based on the evidence presented in these posts.

picture source: http://www.flickr.com/photos/joygant/1447261129/


Gardosi, J., Sylvester, S. and B-Lynch, C. (1989), Alternative positions in the second stage of labour: a randomized controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 96: 1290–1296.

Hobel CJ, Chang AB.  “Normal Labor, Delivery, and Postpartum Care:

Anatomic Considerations, Obstetric Analgesia and Anesthesia, and Resuscitation of the Newborn” in Essentials of Obstetrics and Gynecology, 4th Edition, Editors Hacker, Moore, Gambone.  Elsevier Saunders:

Philadelphia.  2004.

Liddell, H. S. and Fisher, P. R. (1985), The Birthing Chair in the Second Stage of Labour. Australian and New Zealand Journal of Obstetrics and Gynaecology, 25: 65–68

Oxorn, Harry MD Human Labor and Birth (University of Ottawa, Ontario, Canada,McGraw-Hill Professional Publishing)1986

Sax TW, Rosenbaum RB.  Neuromuscular disorders in pregnancy.  Muscle Nerve.  2006 Nov; 34(5):559-71

Shorten, A., Donsante, J. and Shorten, B. (2002), Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth. Birth, 29: 18–27.

Snow, R., Neubert, A. Peripartum Pubic Symphysis Separation:  A Case Series and Review of the Literature.  Obstetrical & Gynecological Survey: July 1997 – Volume 52 – Issue 7 – pp 438-443

Soong B, Barnes M.  Maternal position at midwife-attended birth and perineal trauma: is there an association?  Birth.  2002;32(3):164-169.

Posted By:  Amanda Blaz, DPT

Practice Guidelines, Research, Research for Advocacy, Science & Sensibility, Second Stage, Uncategorized , , , , , , , ,