Childbirth Educators Have an Important Role in Making Change Says Neel Shah, MD

Today is the final day of the 2017 Lamaze Advocacy Summit in Washington D.C. and those in attendance are spending the day on Capitol Hill visiting their congresspeople to speak to the importance of childbirth education in improving maternal-infant health.  Yesterday, attendees heard from Neel Shah, MD, MPP and Ginger Breedlove, CNM, PhD, FACNM.  Dr. Shah spoke on "The Promise and Perils of Consumerism in Maternal Health."  Dr. Breedlove followed up with a critical presentation on "The Importance of Advocacy."neel shah 2017.jpg
The Advocacy Summit helps gather our voices together to be powerful and strong as we share the importance of evidence-based maternal-infant health and the role of childbirth educators in helping to improve birth outcomes.
Dr. Shah and Dr. Breedlove are two of the founders of March for Moms, a non-profit grassroots organization that believes that access to caring, compassionate, and quality medical and mental health services for parents and families is one of the most important components of a healthy society. Their goal in marching for moms on Mother's Day 2017 and in the future, on May 6th, 2018, is to make a more equitable society and health care climate—so all families can live happy, healthy, and free. Before Dr. Shah left on his next adventure here in Washington D.C., before returning to his hometown of Boston, I asked some questions that he graciously answered.  I was very interested in his take on the role of childbirth educators in improving maternal-infant health
Sharon Muza: Why are childbirth educators in a great position to speak to policymakers about the need for significant and critical change in how maternal-infant health is handled and dealt with here in the USA?
Neel Shah: There is no better grassroots army that I can think of than childbirth educators to tell the stories of birthing families--to explain not just what's wrong but to describe what better looks like.
SM: How can childbirth educators help families to become better advocates for their own maternity care?  
NS: We need to find a way to engage families earlier and we need to find ways to meet them where they are (online) rather than in classrooms.
More fundamentally, I believe there is an opportunity for all of us who care about childbirth--clinicians, educators, and families--to do a better job of collectively articulating our highest priority goals so that everyone knows what it is that we are advocating for. We all want the parent and the baby to be safe. But those aren't our only goals, right? What else? Preferences such as immediate skin to skin contact between the new dyad, or just minimizing avoidable interventions are not only about safety. They are about bonding, and self-agency, and achieving the best possible long-term health. These are goals that I suspect everyone who helps care for families will get behind. We should then place our preferences in the context of those goals so that they are not misunderstood as adversarial.
SM: Who really has the biggest responsibility to lead the charge for change in maternity care?  Is it researchers?  Health care providers? Insurance companies?  Paraprofessionals (doulas, childbirth educators?) or is it consumers?
neel shah head shot 2017.jpegNS: We all share equal responsibility and need to affect change together. I don't see why any one party ought to shoulder more of the burden of making things better or why any one party should be let off the hook for the way things are now.
SM: Isn’t the nine (ten) months of pregnancy really too short to expect consumers to be able to affect change while navigating the system themselves?  The learning curve is steep, life is busy and fear is real!  How can we help pregnant people understand the situation on evidence-based maternity care and best practice before they themselves need to be consumers of that type of care?
NS: I would love to see birth become a more prominent part of the public consciousness and public discourse, and I would love to see more representations of birth in media and art and culture that portray it as an empowering process (as opposed to the typical TV or movie depiction of water breaking-->panic-->screeching tires-->screaming-->Ken Jeong-->baby). That being said, I suspect there will always be an aspect of pregnancy and labor and birth and parenting that becomes increasingly real as it becomes more imminent, and there may always be some information that families will reasonably seek out only when they are ready. So as educators, we too need to be ready to use these teachable moments.
SM: What are three “easy” things (or three things in general) that childbirth educators can and should be doing in their childbirth classes to help the families they work with to close the gap on the care they receive against what is best practice so that outcomes can be improved for them and for all?
NS: I have a hard time characterizing anything that childbirth educators do as easy - effective teaching for something as profoundly personal as childbirth requires much more than technical expertise. It requires a sensitivity to the potentially unique needs of the families in front of you and a deep caring and commitment to helping empower them. This last part may be what childbirth educators do best and also the most important thing they do.
SM: Do you think that ACOG is missing the boat in not including the role of childbirth educator as a way to minimize labor interventions (and reduce cesareans.)  In their last two committee opinions (Reducing the primary cesarean and Limiting labor interventions) they mentioned the role of doulas.  Aren’t they missing the inclusion of childbirth educators?  Does the lack of research on this make it hard for them to address the childbirth educator role?
NS: I suspect there are many ACOG members and ACOG leaders who would agree that childbirth education (and those who provide it) are critically important to achieving better outcomes, including decreasing unnecessarily high intervention rates. But yes, all ACOG guidelines are firmly rooted in the available evidence-based literature. Lack of publicly-indexed research is a significant but ultimately surmountable barrier. 
I want to thank Dr. Shah for his time and thought in answering my questions as well as making time to present at the 2017 Lamaze Advocacy Summit.  Dr. Shah's energy seems boundless as he works to improve outcomes for parents and babies.  Please consider heading over to March for Moms and signing up for future updates as the 2018 March comes together.  More on the Advocacy Summit on Thursday, where I share outcomes of visiting Capitol Hill.

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