I attended the Home Birth Consensus Summit, along with our Director of Programs, Carol Sakala, late last week. The meeting was the result of several years of planning by a multi-stakeholder group of maternity care leaders. It was led by facilitators from Future Search, a theory and planning strategy designed around having the “whole system in the room” to find common ground on complex or divisive issues.
Hospitals and Health Systems
From the TMC blog: Making women and families our maternity care system’s “unwavering focus and fully-engaged agents for change”
The prosperity of a nation is tied fundamentally to the health and well-being of its citizens. It follows, then, that citizens—each one a past, current, or future patient—should represent both the healthcare system’s unwavering focus, and its fully engaged agents for change.
This passage begins the new report from the Institute of Medicine’s Learning Health System Series, Patients Charting the Course: Citizen Engagement in the Learning Health System. This report builds on themes addressed in the Institute of Medicine’s landmark report, Crossing the Quality Chasm, which also formed the foundation for the Transforming Maternity Care 2020 Vision.
The Partnership for Patients national program for improving patient safety is one of the first times we’ve seen maternity care on the national agenda, with reducing obstetrical adverse events highlighted as one of ten national priority patient safety areas. Together with the National Priorities Partnership, the Partnership for Patients will offer a free webinar on September 28 about patient safety in maternity care. The webinar will address strategies to meet the national goal of eliminating 30% of preventable obstetrical adverse events and will feature Childbirth Connection’s Maureen Corry.
You’ve probably heard the phrase, “Will it play in Peoria?” It originated in the early ’20s and ’30s during the US vaudeville era, when Peoria, IL was a popular stop for vaudeville acts and performances. If a show was well received in Peoria, it was likely to work throughout the country. Peoria has since become a well-known test market to gauge the popularity of products and ideas nationwide.
So what does this have to do with maternity care? Well, in this case, what’s playing in Peoria goes way beyond products and ideas to a full-blown actionable healthcare quality improvement project called “Healthy Babies, Healthy Moms.”
As we shift the conversation from whether to do VBACs to how to enable more of them, focus on quality and safety in the context of VBAC is long overdue. According to new government statistics, nearly one in five of the more than 4 million births each year in the United States occur to women who have previously given birth by cesarean. If evidence supports VBAC as a “reasonable option” for most of this population and indeed the better option for many, it is time to be reasonable about how to make VBAC as safe, accessible, and satisfying as it can possibly be.
With power outages and last-chance summer vacations, it feels a bit like life has slowed down in anticipation of the busyness that comes with fall. But while conference calls and meetings are a little sparser, the medical literature seems to be serving up a larger than average helping of important evidence and commentary. Maybe your Labor Day Weekend reading list has lighter fare, but here’s what we’re reading…
There’s a big gap between our current maternity care system and the high-quality, high-value system envisioned by a multi-stakeholder Transforming Maternity Care Project Team. We’re glad to see many of the recommendations put forth in the Blueprint for Action garnering broader interest and gaining momentum. Here are four we expect to play a growing role in system transformation over the coming months and years.
From the TMC blog: Will Obstetricians Heed a Leader’s Warning to “Stop the Relentless Rise in Cesarean Deliveries?”
Kudos to Dr. John Queenan for his candid editorial “How to Stop the Relentless Rise in Cesarean Deliveries,” published in the August issue of Obstetrics and Gynecology. We applaud his candor as an obstetric leader willing to confront the serious problems associated with the steadily rising cesarean section rate now approaching 34%.
Dr. Queenan predicts that the significant increase in primary cesareans coupled with the sharp decrease in the VBAC rate will soon result in a 50% cesarean section rate in the U.S.
There’s no doubt that the relentless rise has been a source of anxiety for maternity care stakeholders for at least a decade as the rate has increased year after year. Women feel pressure to accept interventions including major surgery they’re not sure they’ll benefit from, driving a small but rapidly growing group of women to opt for home birth instead. Medicaid programs face severe financial constraints and are set to accept millions of new enrollees in 2014. Given the price tag, Medicaid simply can’t afford a 50% cesarean rate, nor even to sustain the current rate. Obstetricians are now seeing more and more patients with sometimes life-threatening consequences of too many c-sections at unprecedented rates. As Dr. Queenan warns, “the rising cesarean rate is a threat to the profession and there’s no time for complacency.” His editorial ends with a clarion call for concerted action by his profession to confront the problem and commit to action before policy-makers and payers step in and force change.