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.
The quality of maternity care in our country is poor. Childbirth costs more in the United States than in any other developed country, but our maternal and child health outcomes lag behind those of other countries. Too many babies are born at low birth weight. The rates of maternal mortality and prematurity are high. Disparities persist – especially for African American women and babies. And too many women receive unnecessary and unwanted interventions during labor that don’t result in better outcomes.
As Mother’s Day approaches, we renew our commitment to improving the quality of maternity care so women can enjoy safe, satisfying pregnancies and births, and babies can have a healthy start in life. We ask you to join us. We can all play a part in helping pregnant women and newborns get the high-quality care they deserve.
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.
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.
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.
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.
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.”
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:
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.