Posts Tagged ‘Transforming Maternity Care’

Remembering Dr. John Kennell and His Great Contributions to Mothers and Babies Worldwide

September 5th, 2013 by avatar

It was with great sadness that I read about the death of Dr. John Kennell on August 27, 2013 in Cleveland, OH.  Dr. Kennell, a pediatrician and researcher, had a long history of contributions to the field of maternal infant bonding and attachment, especially at birth and in the early postpartum period  

Every time a mother opens her arms to receive her newborn baby on her chest (in line with Lamaze Healthy Care Practice #6) at the moment of birth it is a credit to the work of Dr. Kennell and his colleagues, especially his longtime collaborator,  Dr. Marshall Klaus.  Dr. Kennell examined and researched the connection (both physiological and emotional) of the newborn and its mother.  As a result of his research, the practice of separating mothers from their babies for hours or even days after birth has all but disappeared in the USA and many places around the world. Prior to Dr. Kennell’s work, little was understood about the newborn’s innate need to be close to and kept with its mother as it made the transition to life on the outside.

Our results reveal suggestive evidence of species-specific behavior in human mothers at the first contact with their full-term infants and suggest that a re-evaluation is required of the present hospital policies which regulate care of the mother and infant. (Klaus, 1970)

Additionally, Dr. Kennell helped clarify the importance of families connecting with their babies who did not survive or died shortly after birth.  Suggesting that time to hold, examine, and say goodby to a baby who passed away was helpful in processing grief and coming to terms with their loss,  has changed how stillbirth and neonatal death is handled in our hospitals.  For babies who are in the neonatal intensive care unit, the importance of promoting mother-infant bonding and attachment is now recognized as a critical part of the care plan.

Dr Kennell’s research has caused hospitals to completely change the methodology of the birth and postpartum experiences for the babies born in there facilities, supporting contact during the first hours and instituting a “rooming-in” policy that allowed mothers and babies to stay together during the postpartum stay.  Even NICU facilities are accommodating parents with couches that turn into beds right on the units, near the babies needing care special care.

These observations suggest that there may be major perinatal benefits of constant human support during labor. (Rosa et.al. 1980)

Dr. Kennell was one of the very first scientists to research and investigate the benefits of continuous labor support for birthing women, and along with Dr Klaus, Penny Simkin, Annie Kennedy and Phyllis Klaus, founded Doulas of North America, which later became DONA International, a well respected, worldwide doula organization committed to training both birth and postpartum doulas and providing a doula for every woman who wants one.  Since being established in 1992, DONA International has certified over 8000 birth and postpartum doulas and has members in over 50 countries around the world.  Many, many thousands of women have birthed with the support of doula, enjoying the benefits observed by Drs. Kennell and Klaus when they first started their research, and documented again and again since then; shorter labors, lower cesarean rates and reduced interventions. (Kennell, et. al. 1991)

If a doula were a drug, it would be unethical not to use it. – John Kennell, M.D.


© http://flic.kr/p/tvZYD

Dr. Kennell was the co-author of several books, including “Bonding: Building the Foundations of Secure Attachment and Independence” and “The Doula Book: How a Trained Labor Companion Can Help You Have A Shorter, Easier and Healthier Birth.” as well as a goldmine of research papers.  He was known for his gentle, caring and compassionate nature as well as his brilliant mind and wonderful sense of humor.

Please join me in extending the deepest sympathies of birth professionals everywhere, to Dr. Kennell’s wife, children and their families during this time of loss.  The memory of this esteemed doctor will live on in the work we all do to improve the childbirth experiences of women everywhere.  I am grateful that I have the chance to continue in some small way, the legacy of the brilliant contribution that Dr. Kennell made to women and babies worldwide.  Dr. Kennell’s family has requested that in lieu of flowers,  donations be made to DONA International or HealthConnect One. Dr. Kennell’s full obituary can be found here.

Please share  in the comments section, the impact that Dr. Kennell’s work has had on you.  He was very important to all of us.


Kennell, J., Klaus, M., McGrath, S., Robertson, S., & Hinkley, C. (1991). Continuous emotional support during labor in a US hospital. JAMA: the journal of the American Medical Association265(17), 2197-2201.

Klaus, M. H., Kennell, J. H., Plumb, N., & Zuehlke, S. (1970). Human maternal behavior at the first contact with her young. Pediatrics46(2), 187-192.

Sosa, R., Kennell, J., Klaus, M., Robertson, S., & Urrutia, J. (1980). The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. New England Journal of Medicine303(11), 597-600.



He is a featured speaker on this DONA International video. In it, Dr. Kennell

“If a doula were a drug, it would be unethical not to use it.” 1998
The Essential Ingredient: Doula

shares his great respect for the doula’s role in establishing a strong foundation for mothers and babies.


Our hearts go out to Dr. Kennell’s family, especially his wife Peggy. The family has asked that in lieu of flowers, donations be made to DONA International or HealthConnect One, which were his passions. Further details about how to make donations in his honor will be available on our website soon.


Rest in peace, Dr. Kennell. Thank you for all of the gifts you offered up to the world. Our lives are transformed because of you.

Babies, Breastfeeding, Childbirth Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Maternal Quality Improvement, Maternity Care, Newborns, Transforming Maternity Care , , , , , , , , ,

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 , , , , , , , , , ,

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)


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 , , , , , , , ,

Lamaze International Webinar: “Arming Women with the Tools to Push for the Safest, Healthiest Birth Possible.”

November 20th, 2012 by avatar

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


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.


Linda Harmon
Executive Director/CEO
Lamaze International

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

Babies, Christy Turlington Burns, Continuing Education, Healthy Birth Practices, Healthy Care Practices, Lamaze International, Lamaze News, Maternal Quality Improvement, Push for Your Baby, Webinars , , , , , , , ,

How to Get Good Maternity Care

December 20th, 2011 by avatar

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

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

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




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

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

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


Maternity Care With a Heart from Childbirth Connection on Vimeo.



Posted by:  Amy Romano, MSN, CNM

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

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