The current state of maternal-infant care, especially in the United States, has resulted in the prematurity rate on the increase once again, one in three people birthing by cesarean, and approximately 40 percent of birthing people being induced with less than ideal outcomes. Health care expenses are simply astronomical, rural areas of the country struggle to maintain obstetrical services and our most underresourced populations (families of color and those with low socioeconomic status) are most severely impacted, with birthing people four times more likely to die during the prenatal, intrapartum and postpartum period. Babies of color are twice as likely to die in their first year of life versus their white peers. To put it bluntly, the state of maternity care in the United States is in crisis.
Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing, authored by 17 leading maternity experts and released on June 28, 2018, by the National Partnership for Women & Families aims to outline and promote "well-tested, evidence-informed strategies" that can be used as a guideline to address current systems that are failing childbearing families.
This comprehensive and thorough report builds a foundation by recommending "six strategies to advance high-value maternity care by promoting, supporting and protecting women’s innate capacity for healthy childbearing and by safely limiting use of consequential interventions around the time of birth." These strategies and recommendations are respectful, as they should be, to the medical/health status of the dyad and the preferences of the family. The blueprint includes action steps that can be taken by maternal-infant health systems, policymakers, clinicians, administrators, health plans, employers, researchers, birth workers, advocates and women and families themselves. There is something for everyone, no matter how they fit into the landscape of maternity care in the USA. I am thrilled that everyone can see themselves as having a responsibility to improve our outcomes. No one organization or person created the current situation and it will take a coordinated effort of many working together to improve outcomes for families today.
The six strategies are:
- Reward health care providers and systems that deliver quality, woman-centered maternity care. Through innovation in how we pay for and deliver maternity care, health care leaders can improve the quality and lower the cost of this care by minimizing both overuse and underuse and encouraging the adoption of high-performing elements of maternity care – such as continuous labor support and breastfeeding support.
- Prioritize measuring – and reporting on – the quality of maternity care. Performance measurement experts and decision-makers should fill gaps in standardized performance measures to enable providers, women and others to obtain and use quality information.
- Meaningfully engage women and families in maternity care. Consistent, widespread use of shared care planning and shared decision-making, among other tools, would help ensure that women and families are at the center of – and fully engaged in – efforts to improve maternity care.
- Change how we educate the maternity care workforce. All levels of education should support maternity care clinicians in shared knowledge and skills for physiologic childbearing, effective team-based care and shared decision-making.
- Build up the maternity care workforce. To address the growing shortage of maternity care providers in United States and better meet the needs of an increasingly diverse population of childbearing women, we need to better retain and deploy physicians, increase use of midwives and build a workforce that better reflects the diversity of childbearing families.
- Prioritize and support research to advance the science of physiologic childbearing and its effect on maternal and child health. Research on perinatal physiology, clinical epidemiology and implementation science is critical for driving meaningful improvements in maternity care and strengthening maternity care policies, programs and services.
Childbirth education is a priority recommendation specifically addressed in the Blueprint in Section 3a - Expand Communication and Education.
"Increase access to evidence-based childbirth education that begins early in pregnancy and prepares women to communicate effectively with care providers. This childbirth education should help women understand the value of and tips for experiencing healthy perinatal physiologic processes; the evidence and indications for common perinatal interventions; and evidence-based options for decisions they are likely to face before, during and after childbirth. Evaluate the effects of such education."
Lamaze certified educators already are doing this work around the world, and we can continue to increase the numbers of trained and certified educators who can help reach pregnant families. As part of strategic planning initiatives developed at the 2018 Strategic Planning Meeting, Lamaze is working hard to develop research protocols to evaluate the effects of our programs on birth outcomes and families' experiences.
Carol Sakala, the Director of Childbirth Connection Programs for the National Partnership for Women & Families shared with me that “A central quality improvement principle is: Every system is perfectly designed to get the results it gets. Our 17 multi-stakeholder, multi-disciplinary co-authors collaborated to point the way to a system that will more reliably meet the needs of all childbearing families and newborns. We are confident that this new Blueprint can lead to a fuller, safer, more complete and effective maternity care system. We invite all who are involved with the care of childbearing families to share this document, absorb it and identify recommendations they can implement.”
I invite all of you to absorb this groundbreaking guide to maternal-infant health and determine where you can lean in and put into practice or expand upon your current efforts to support physiologic childbirth through quality evidence-based educational offerings.