Posts Tagged ‘quality improvement’

Focus On: Childbirth Connection

May 5th, 2011 by avatar

Nearly a Century of Innovation

Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association (MCA) to reduce maternal and infant mortality in New York City. By fostering access to high-quality prenatal, childbirth and postpartum care and education that met the needs of underserved women, MCA achieved significant measured success. This focus on effective ways to improve the quality of maternity care and address best interests of women, babies, and families has continued throughout the organization’s history.

Improving Maternity Care in the 21st Century

In the decades that followed, MCA provided leadership inaugurating and strengthening many core elements of the maternity care system and related health policy, including: maternity nursing, childbirth and parenting education, nurse-midwifery education and credentialing, out-of-hospital birth centers, program evaluation, collaborative practice, and public education.

As the 20th century came to a close, MCA assessed contemporary maternity services and the wealth of best available evidence on care for pregnancy and childbirth. We found that many important lessons from the best research were not being translated into routine maternity care practice. To address this evidence-practice gap, MCA inaugurated in 2000 a long-term national program to promote evidence-based maternity care through three strategies: research, education and advocacy.

Since that time, the organization has commissioned and conducted many systematic and narrative reviews to clarify best evidence regarding safety and effectiveness of important maternity practices, conducted three pioneering national surveys of women’s childbearing experiences, carried out national media outreach campaigns to educate women and the general public about safe and effective maternity care, developed and updated an award-winning website with evidence-based resources for women and health professionals, engaged consumers in providing feedback to improve reviews of research, informed health professionals about safe and effective maternity care through leading professional journals, and raised awareness among elected officials and policymakers about the need to improve maternity care.

In 2006, MCA became Childbirth Connection to better reflect its contemporary focus and expanded its mission statement to improve the quality of maternity care through research, education, advocacy, and policy. Through its Maternity Quality Matters Initiative, Childbirth Connection focuses on policy as a core strategy to foster a maternity care system that delivers care of the highest quality and value to achieve optimal health outcomes and experiences for mothers and babies.

Childbirth Connection is taking advantage of the country’s current unprecedented focus on health care quality improvement by engaging leaders from across the health care system to ensure that maternity care is provided in ways that are safe, effective, woman-centered, timely, efficient, and equitable. In collaboration with the Reforming States Group and the Milbank Memorial Fund, Childbirth Connection issued a major report, Evidence-Based Maternity Care: What It Is and What It Can Achieve (2008). The report assesses the present maternity care system and identifies barriers and opportunities for improvement. Through Childbirth Connection’s landmark policy symposium, Transforming Maternity Care: A High Value Proposition, its 2020 Vision for a High Quality, High Value Maternity Care System, and Blueprint for Action, the organization works to improve the structure, process and outcomes of maternity care in the 21st century. Childbirth Connection believes that deliberative, collaborative multi-stakeholder efforts to improve the quality, value and experience of care for women, babies, families, and other stakeholders are the way to get there. We know that maternity quality matters.

Resources for Childbirth Educators:

Posted by:  Amy Romano, CNM, MSN


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The Transforming Maternity Care Toolbox

April 19th, 2011 by avatar

At Childbirth Connection, one of our mantras is: A high-quality, high-value maternity care system is within reach, but none of us can do it alone. The Transforming Maternity Care “2020 Vision” and “Blueprint for Action” reports, released last year, involved intense collaborative work by all stakeholders – from delivery system leaders, providers, and consumers to health plan and purchaser leaders, liability insurers and quality experts. But these consensus documents are just the beginning. The devil is in the details, and much more work is needed to implement the Blueprint’s recommendations and continually refine quality improvement efforts.

To foster and accelerate implementation, Childbirth Connection just launched a new Transforming Maternity Care web site. Whereas ChildbirthConnection.org offers evidence-based information to women and health professionals to aid decision making, the Transforming Maternity Care site addresses system reform. We thought about four major factors that could get in the way of our collective ability to seize unprecedented opportunities to effect real change, and set out to offer solutions.

Problem: The 2020 Vision and Blueprint for Action are robust but dense and may be hard to digest at once.

Solution: This problem was easy to address. The Vision and Blueprint now each have home pages of their own, and the content is delivered in smaller chunks in both HTML and PDF. Want to know about how performance measurement fits into maternity care system improvement? Go straight to the performance measurement page. From there you have the key messages available at a glance or you can drill deeper to understand the problems in the current system and read the in-depth recommendations and action steps. You can also download the full-text of that Blueprint section (pdf). Also at your fingertips: watch a webinar, access a bibliography of studies, reports and other background materials, and search for projects in our Transforming Maternity Care Directory that address performance measurement.

Performance measurement isn’t your cup of tea? Just pick any of the 10 other focal areas (like care coordination, informed decision making, or liability reform) and drill down the same way.

Problem: Many individuals and organizations want to help fix maternity care, but stakeholders may not know where to begin.

Solution: Behold: the Action Center. No matter what kind of stakeholder you are, there’s something you can begin doing today to help improve maternity care. We’ve pulled together the most promising opportunities for consumers, health professionals, hospital and health system administrators, purchasers, and quality experts.

Problem: Energy and resources are easily wasted reinventing the wheel.

Solution: There are many examples of high-performing maternity care services and successful quality improvement efforts. But it can be difficult to translate effective models into widespread practice. What’s more: all change is local – stakeholders need tools and support to adapt innovations to their own settings and populations.

To foster, coordinate, and accelerate maternity care quality improvement, we put the tools and resources in one place and set up a way to connect individuals and organizations with common interests. The site features a directory of quality improvement projects that users can browse by Blueprint area or by quality improvement strategy. Are you improving maternity care quality where you live or work? Add your project to the directory.

Other resources include a list of quality improvement toolkits, links to obstetric and perinatal safety courses for health professionals, a directory of quality collaboratives, and a bibliography of the quality improvement literature.

One stop shopping!

Problem: Data to track and improve maternity quality are collected by many different agencies and reported on many different web sites.

Solution: We’ve created a Data Center where you can find statistical reports, interactive maps, and raw data files to help understand and improve maternity care quality. The data center is where you’ll find Childbirth Connection’s Listening to Mothers surveys, our continually-updated Facts & Figures page, and cost and payment data. We’ve also collected all provider-, facility-, and state-level maternity care data that we know is available, and provided links in one place. Last but not least, the data center includes our interactive maternity care map from Mapping Health, the winner of Childbirth Connection’s Health 2.0 Developer Challenge.

We hope these resources help and inspire you to make change. If there is a quality improvement toolkit or resource that you think should be listed on the site, please let us know. If you have any other feedback about the new site, contact me at romano@childbirthconnection.org. And don’t forget, if you are involved with a quality improvement project, there’s someone else who wants to know about it, and might even want to replicate it. Please fill out our project submission form to share your story.

Posted by:  Amy Romano, CNM

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No more excuses: video trains hospital staff in the whys and hows of skin-to-skin after birth

June 13th, 2010 by avatar

[Editor’s note: This is a guest post from former Lamaze International President, Jeannette Crenshaw. When Jeannette told me about the video she reviews in this post, I knew I wanted to highlight it as part of the Sixth Healthy Birth Blog Carnival.

I recall  one birth I attended as a midwife, I had to negotiate with the nurse about how long we would “let” the mother and baby remain in skin-to-skin contact after birth. Her reason for wanting to disrupt skin-to-skin time? “I have to put the baby in the computer.” Her job (completing birth documentation) was interfering with her job (safeguarding the health and wellbeing of the mother and baby).

Hospital routines are the #1 reason mothers and babies are denied skin-to-skin contact after birth. Changing this  harmful practice is possible, but it takes a commitment to quality and systems improvement.  Now that the Joint Commission is measuring hospital perinatal quality by the proportion of babies exclusively breastfed at discharge,  hospitals need concrete tools to retrain staff and change delivery room culture. Hospitals: it seems like this video may be $39.00 well spent. – AMR]

Skin to Skin in the First Hour After Birth:
Practical Advice for Staff After Vaginal and Cesarean Birth (DVD)

Executive producer and videographer: Kajsa Brimdyr, PhD, CLC; executive and content producers: Kristin Svensson, RN, PhD (cand.) and Ann-Marie Widström, PhD, RN, MTD.
$39.00 at Healthy Children

scan0004A new DVD from Healthy Children Project should be mandatory viewing for every labor and delivery nurse and birth attendant. It will help maternity health professionals in hospital settings to implement the best practice of uninterrupted skin to skin care beginning immediately after birth until after the first feeding. This is a “how to” DVD, with the practical advice health professionals need to provide clinical care to mothers and babies who are skin to skin immediately after a vaginal or cesarean birth.

The 40 minute DVD, set to original music by J. Hagenbuckle, has 3 content sections, and a section with a complete list of references. The first section describes the short and long term benefits of skin to skin care for newborns and mothers. It shows the 9 stages healthy newborns experience while skin to skin during the first hour after birth—from the birth cry (stage 1), through suckling (stage 8), and sleep (stage 9). The narrator emphasizes the individual way each baby moves through the 9 stages.

The second section shows how to provide care for mothers and babies while they are skin to skin, after a vaginal, and the third, after a cesarean birth. Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments. Nurses remove birth fluids as they dry the baby—delicately addressing the common concern that babies should first be “cleaned up” at a warmer. Nurses remove wet blankets, place the baby skin to skin, and cover mom and her baby with warmed blankets. Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

I strongly recommend this DVD (only $39.00) for staff in any maternity setting. Childbirth educators will find the first section of the DVD a great addition to their prenatal childbirth and breastfeeding classes (although Breastfeeding—A Baby’s Choice, 2007, may be a better choice). Staff who are working to help their hospitals achieve Baby-Friendly designation will find this DVD useful for training. The narrator uses, for the most part, simple and non-clinical language and the video of mothers and babies will quickly engage the viewer. The DVD’s producers met their objective: “to assist staff in providing behaviorally appropriate, individualized, baby adapted care for the full term newborn using the best practice of skin to skin contact in the first hour after birth”.


Healthy Children Project. (Producer). (2007). Breastfeeding—A Baby’s Choice [DVD]. Available from http://www.healthychildren.cc/

Jeannette Crenshaw, MSN, RN, NEA-BC, IBCLC, LCCE, FACCE is a member of the graduate faculty at the University of Texas at Arlington College of Nursing and a family educator at Texas Health Presbyterian Hospital Dallas. She represents Lamaze on the United States Breastfeeding Committee (USBC) and coordinates the Lamaze Breastfeeding Support Specialist Program. She has published articles and presented nationally and internationally on a variety of topics, including evidence based maternity care.

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