The country’s maternity care system is missing opportunities to provide better care and use resources more wisely by routinely intervening in labor and delivery in ways that interfere with, instead of promoting, supporting and protecting, innate biological processes that result in healthier outcomes for women and newborns. That is the conclusion of a major new report, Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. The unprecedented synthesis of scientific research on how hormone systems function from late pregnancy through the early postpartum period concludes that commonly used maternity interventions —– such as labor induction, epidural analgesia, and cesarean section &mdashl can disturb hormonal processes and interfere with the benefits they offer.
The preeminent medical journal The Lancet has just released its Midwifery Series, a major project to take stock of the contribution of midwifery to the well-being of childbearing women and newborns. All content from this remarkable Series is freely available after complimentary journal registration.
One of most commonly cited barriers to improving maternity care is the risk of providers and hospitals being held liable for bad outcomes. Whether it is reining in overuse of tests and procedures, honoring women’s preferences, or increasing interdisciplinary collaboration, good ideas often cannot move forward once the issue of liability is raised.
If we cannot make progress toward more evidence-based, woman-centered care because of liability concerns, then the liability system is functioning poorly. But what are the aims of a high-functioning liability system? Is it just to avoid lawsuits and hold liability insurance premiums down?
In our new report, Maternity Care and Liability, we hold 25 possible liability reforms up to a framework that addresses the needs and interests of all of the system stakeholders: those who deliver care, those who pay for care, and most importantly, the women and newborns who receive care. We developed this framework based on maternity care and liability studies and with the input of clinicians, legal scholars, consumer advocates, policy makers, and others.
At Childbirth Connection, we know that performance measurement is an essential element for moving toward the maternity care system that women and families deserve — one that meets the Triple Aim of better care, better outcomes, and better value. Performance measurement is central to our 2020 Vision for a High-Quality, High-Value Maternity Care System and companion Blueprint for Action consensus reports. So, we are thrilled that the National Quality Forum (NQF) has approved for endorsement 12 continuing and 2 new maternity care performance measures.
Pending a 30-day appeal period, these will continue to be available or be newly available as nationally endorsed performance measures for both quality improvement and public reporting. I am pleased to offer this update as co-chair of the multi-stakeholder Steering Committee that evaluated measures submitted by developers within the formal NQF consensus development process with explicit criteria for endorsement.
From the TMC blog: Upgrading the tools to guide practice: IOM issues new standards for systematic reviews and clinical guidelines
Thousands of systematic reviews about maternal and newborn care have been published, and more and more are released every week. We clearly have guidance for many important questions related to safe effective practice, so why don’t we have a high-quality, high-value maternity care system? The trustworthy evidence must be translated in practice, a tall order. Also, we cannot improve practice, without first doing a good job of interpreting the research evidence.
Two much-needed recent companion reports from the Institute of Medicine will help us interpret the evidence.