Blog: Transforming maternity care

Helping Pregnant Women Become Partners in Their Care

From the desk of: Maureen Corry

The quality of maternity care in our country needs improvement. While transforming the maternity care system will take time, there is progress to report.

In February, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released a groundbreaking consensus statement on the overuse of cesarean. The statement confirms that the procedure is too often used in ways that do not improve maternal and child health outcomes.

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Filed in Blog, New Reports and Resources on Mon., Apr 14, 2014

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Listening to Mothers III survey shows moms deserve better in pregnancy and birth

We recently published the results of Listening to Mothers III, the third national U.S. survey of women’s pregnancy and birth experiences. As with previous Listening to Mothers surveys, the latest data show that risky procedures are overused, many beneficial practices are underused, and all too often women lack the support and knowledge required to effectively navigate their maternity care.

We’ve made it easier than ever for you share the survey findings to help improve policy, practice, research, and advocacy.

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Filed in Blog, New Reports and Resources on Tue., May 28, 2013

The Leapfrog Hospital Survey now reports episiotomy rates

The Leapfrog Group, a patient safety organization comprised of employers and other purchasers of employee health coverage, has reported measures of maternity care safety for several years, most notably with their survey of hospital rates of early elective deliveries. This year’s Leapfrog Hospital Survey highlights hospital rates of episiotomy. The public can compare episiotomy rates within a city, state, or region. An episiotomy is a surgical cut to enlarge the vagina for vaginal birth. Evidence suggests that routine or frequent use of episiotomy does not benefit babies but increases mothers’ pain, reduces pelvic floor strength, and may predispose women to extensive tears that involve anal sphincter muscles. Despite the evidence, episiotomy rates remain high in some settings.

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Filed in Blog, Hospitals and Health Systems, New Reports and Resources on Mon., Apr 1, 2013

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Shared Decision Making in Maternity Care

Along with our partners at the Informed Medical Decisions Foundation, we are celebrating Shared Decision Making Month, and last week the spotlight was on maternity care. Maureen Corry was interviewed as part of a series on Shared Decision Making Along the Continuum of Care. Then she moderated a webinar about maternity care shared decision making with Kim Gregory, MD, MPH and Ob-Gyn and Vice Chair of Women’s Healthcare Quality and Performance Improvement at Cedars-Sinai in Los Angeles, Kate Chenok, Director at the Pacific Business Group on Health, and Kristen Oganowski, a mother, doula, and blogger at Birthing Beautiful Ideas.

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Filed in Blog, Clinicians, Consumers on Mon., Mar 18, 2013

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It’s Been 95 Years, Baby!: A Closer Look at Our First Decade

Childbirth Connection is celebrating our 95th birthday this year by featuring one decade of our work each month on the TMC Blog. This month we will feature our first decade – 1918-1927.

Childbirth Connection was founded in New York City as the Maternity Center Association (MCA) in 1918 to implement recommendations from a report on the poor health of women and infants around the time of birth. At the time there were no standards for maternity care, many women lacked access, and infant and maternal mortality rates were high.

By 1920, MCA had established 30 centers and substations throughout the city to ensure universal access to prenatal care and to teach the community about the value of such care. The nurses at the centers helped select the women needing hospital care and refer them to hospitals, and helped the women planning to give birth at home to make arrangements for adequate care. To coordinate this work, MCA created a standard record and a central clearinghouse for all maternity records “to prevent duplication in the maternity work throughout the bureau and to assign to the various agencies those patients reported to the clearing house as in need of prenatal supervision.”

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Filed in 95 Years, Blog on Fri., Mar 1, 2013

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Seeking participants for a video about labor induction decision making

Childbirth Connection and the Informed Medical Decisions Foundation are seeking women who have given birth within the past 2 years to appear in video segments of an online shared decision making guide. We are specifically seeking women who considered or were offered induction of labor before 41 weeks of pregnancy for a non-medical reason. A non-medical reason might include to give birth with a certain doctor/midwife, to plan around maternity/paternity leave or family needs, to get relief from discomforts of pregnancy, etc. We want to talk to women who did choose induction of labor as well as those who were offered elective induction or considered it on their own but decided to wait for labor to start on its own. At this time, we are seeking women who did not have any pregnancy complications such as diabetes, high blood pressure, or a breech baby.

If we select you to be featured in the program, you will receive payment for your time, and a video crew will come to your home or another location near you to film.

If you are interested, please complete the brief form below:

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Filed in Blog on Fri., Feb 22, 2013

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“Choosing Wisely” in maternity care: ACOG and AAFP urge women to question elective deliveries

Last April, the ABIM Foundation, with Consumer Reports and other partners, drew national attention to overuse of ineffective and harmful practices across the health care system with their Choosing Wisely campaign. As part of the campaign, professional medical societies identified practices within their own specialties that patients should avoid or question carefully. Today, the American Congress of Obstetricians and Gynecologists (ACOG) and the American Association of Family Physicians (AAFP) have joined the campaign, drawing national attention to the overuse and misuse of induction of labor. ACOG and AAFP are telling women and their maternity care providers:

- Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
- Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.

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Filed in Blog, New Reports and Resources on Thu., Feb 21, 2013

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5 reasons birth centers have met their moment

Childbirth Connection has been advocating for greater access to birth centers for much of our 95 year history. We opened the first urban birth center in 1975 and helped found the organization that would later become the American Association of Birth Centers (AABC). Our director from 1970 to 1995, Ruth Lubic, went on to win a MacArthur “Genius” Award for her pioneering work in birth center innovation. Although the number of birth centers has increased in the intervening decades, birth centers remain a very small segment of the health care system. Just 0.3% of U.S. births take place in birth centers.

But a new study out today and a congressional briefing next week are sure to heighten attention to this high-quality, high-value care option. Added to other trends and recent developments, we anticipate this new study will trigger rapid growth in birth centers, and more focused and innovative efforts to integrate birth centers into the health care system. Here are 5 reasons birth centers have met their moment.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources on Thu., Jan 31, 2013

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Fixing persistent liability concerns in maternity care: We can do it!

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.

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Filed in Blog, Clinicians, Consumers, Costs - Charges - Value, Hospitals and Health Systems, New Reports and Resources on Wed., Jan 9, 2013

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Overuse of c-sections: bad for women, babies, and the bottom line

Last month, Childbirth Connection issued Cesarean or Vaginal Birth: What Is At Stake for Mothers and Babies, a best evidence review cataloging dozens of adverse outcomes made more common by cesarean surgery. Maternal infections, prolonged pain, life-threatening complications, and childhood chronic illnesses – evidence demonstrates cesarean increases the likelihood of each of these. These risks are appropriate tradeoffs in some circumstances when cesarean offers a clear benefit. But a growing chorus of obstetric leaders and maternity care reformers are warning that the c-section rate is too high. For the benefit of public health – for the 4 million women who give birth every year and their 4 million babies – we must work to safely rein in the overuse of c-sections.

Today, we learn the extent to which c-section overuse is driving up health care costs, too. Together with Catalyst for Payment Reform and the Center for Healthcare Quality and Payment Reform, we have issued The Cost of Having a Baby in the United States, prepared by Truven Health Analytics.

What is at stake for payers? Not only do unwarranted c-sections create greater health risks for women and babies, this study shows that they also dramatically increase costs for employers and, through Medicaid programs, state and federal budgets.

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Filed in Blog, Costs - Charges - Value, New Reports and Resources on Mon., Jan 7, 2013