I have talked before about the importance of offering an early pregnancy class to families who are welcoming a baby. One of the biggest risk factors for having a cesarean section is what hospital someone chooses to give birth at. Having families attend an early pregnancy class is one way that a childbirth educator can share information that can really make a difference in the type of birth one has. Yesterday, one of my colleagues, Pam Vireday, an occasional contributor to Science & Sensibility, wrote a post on her own blog, The Well-Rounded Mama, titled "Hospitals with Midwives on Staff Have Better Outcomes."
In her recent blog post, Pam summarized two new studies that demonstrated that having midwives and doctors practicing on staff together at a facility improved the outcomes, even if the pregnant person was seeing a physician. Both of these studies examined the outcome of "midwifery presence on staff" where midwives and doctors worked in an "interprofessional center" of collaboration. The outcomes of births in these interprofessional situations were better.
As Pam discussed upon her review, the research showed that people birthing in facilities with both midwives and doctors on staff were less likely to be induced, less likely to have their labor augmented with pitocin, less likely to have a cesarean, and more likely to have a successful vaginal birth after cesarean. It appears that the presence of midwives on staff influenced the care being offered by all the health care providers to the families choosing to birth there, even if the patients themselves were under the care of physicians.
I have noticed this anecdotally myself here in Seattle, when I attend births as a doula and teach lots of new families. Facilities that have this type of collaboration seem to have less routine interventions and better outcomes. Lamaze International's fourth Healthy Birth Practice is "Avoid Medical Interventions that are Not Routinely Necessary." For families, making a choice to birth in a facility that offers this interprofessional center, (midwives and doctors) may increase their chances of a safe and healthy birth experience.
This brings me back to the early pregnancy class idea. By the time most people take a childbirth class, they are commonly in their third trimester and have experienced a long course of prenatal care with their current provider. While some families consider making a change (and even fewer actually do) in late pregnancy, offering an early pregnancy class gives childbirth educators the opportunity to discuss what the research shows about the facility someone chooses to birth in makes a world of difference.
Reaching people when they are just initiating prenatal care, or have not yet established a strong relationship with a provider allows space for families to consider what the research shows: where you birth matters and birthing in a facility where there are both doctors and midwives also contributes to birth outcomes.
With the new year just a few days old, maybe now is the time to consider adding an early pregnancy class to your class offerings. More and more research is demonstrating the importance of reaching people early so they can make the best decisions possible for a safe and healthy birth.
I know many of you have discussed before that you have tried offering these early classes without much success. Let's not give up. We just have to find the right combination of recruitment techniques and information to reach families at this porous and important time in their pregnancy. If we are able to do so they can learn early on what they often find out much too late in their pregnancy (or even after the birth) - where one gives birth matters! I might be ready to give this a try!
Carlson, N. S., Neal, J. L., Tilden, E. L., Smith, D. C., Breman, R. B., Lowe, N. K., ... & Phillippi, J. C. (2018). Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study. Birth.
Neal, J. L., Carlson, N. S., Phillippi, J. C., Tilden, E. L., Smith, D. C., Breman, R. B., ... & Lowe, N. K. (2018). Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study. Birth.