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.
Hospitals and Health Systems
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.
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.
Back in April, Carol Sakala wrote about the new and continuing perinatal and reproductive health quality measures endorsed by the National Quality Forum. The final Technical Report on the set of NQF-endorsed measures is now available.
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.
On March 31, the eve of Cesarean Awareness Month, the National Health Policy Forum addressed the rising rate of cesarean section in the United States. The Forum is a non-partisan organization that offers educational programming and other health policy resources to congressional and federal agency staff.
Caesar’s Ghost: The Effect of the Rising Rate of C-Sections on Health Care Costs and Quality, explored the drivers and consequences of the increasing c-section rate and public- and private-sector initiatives to achieve a more optimal rate. Forum presenters included:
- Maureen Corry, who presented results of Childbirth Connection’s Cesarean Evidence Project and the Listening to Mothers surveys and shared recent national data on cesarean and VBAC rates, average hospital charges for cesarean and vaginal births, and cost comparisons across industrialized countries. Her presentation also reviewed progress on key recommendations from the TMC Blueprint for Action.
- Jeff Thompson, MD, Chief Medical Officer for the Washington State Medicaid Program, who presented about the state’s multiple strategies to reduce cesarean section. These include licensing and reimbursing fees for birth centers and Certified Professional Midwives and testing payment reforms to penalize early elective deliveries and incentivize VBAC.
- Andréa Caballero Dilweg, from Catalyst for Payment Reform (CPR), who shared purchaser strategies from CPR’s Payment Reform Toolkit and Maternity Care Special Initiative.
- Frank Mazza, MD, Chief Patient Safety Officer at Seton Healthcare Family in Austin, TX, who discussed Seton’s award-winning perinatal safety program that reduced birth injuries, instrumental vaginal deliveries, and NICU admissions without increasing the use of c-section.
Earlier this year, the Center for Medicare and Medicaid Innovation (CMMI) announced Strong Start, a major federal initiative to improve birth outcomes among Medicaid enrollees. (Letters of Intent are now due May 11, 2012.) The initiative includes a funding opportunity for three innovative models of prenatal care delivery that show promise for reducing preterm births. Two of the three models have national organizations that define and promote them: group prenatal care models like CenteringPregnancy and prenatal care in birth centers, a model promoted by the American Association of Birth Centers. The third model has left some people scratching their heads: Maternity Care Homes. What is a Maternity Care Home and, more importantly, what changes do practices have to make to become one?
The purpose of this article is to foster awareness and discussion about Maternity Care Homes and to encourage Strong Start applicants to advance this model. The article will answer common questions about Maternity Care Homes, with an emphasis on implementation. If you have other questions, please leave them in the comments.
One year ago, the Leapfrog Group released results of their annual Hospital Survey, for the first time publicly reporting rates of early elective deliveries (inductions or planned c-sections occurring before 39 weeks without a medical reason). The results were shocking, with hospitals varying from virtually zero to well over half of elective deliveries occurring before 39 completed weeks. Last week, we partnered again with the Leapfrog Group and other organizations to publicize the release of this year’s survey results, and we’re pleased that the data show rates moving in the right direction.
Our Leading Change series profiles leaders in efforts to transform maternity care. This month we bring readers an interview with Christine Morton, PhD, a medical sociologist at the California Maternal Quality Care Collaborative. Christine and I discuss the rising rate of maternal mortality, how standardizing care for obstetric hemorrhage can help, the need for better data collection and reporting, and how state quality collaboratives can lead change. Thanks Christine for taking the time to answer these questions, and thanks everyone at CMQCC for your work to transform maternity care!
For the first time, major U.S. maternity care professional organizations have issued a joint statement on maternity care quality. Titled, Quality Patient Care in Labor and Delivery: A Call to Action, the white paper comes out strongly in favor of: woman- and family-centered care, including effective and culturally sensitive communication; shared decision making effective teamwork, especially during obstetric emergencies; and performance measurement and leveraging of results to improve quality.