As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.
Scope of covered services
In our local area (St. Louis, MO), access to doulas has largely been for those with the knowledge, money and opportunity (i.e. middle class, white women). Purple Lotus Doulas was founded as a collective of doulas who are dedicated to providing doula services across the full spectrum of women and pregnancy, regardless of any socio-economic or other issues. Each of the doulas in our collective has worked with a variety of populations, either on a professional or volunteer basis. Although we do accept private, for pay clients, we are all available for reduced pay or free doula services. We are also active in the birth community, with the goals to improve access to health services, change or maintain laws that benefit our target populations, and provide education to the general public.
The Birth Trust provides funding for projects that advance midwifery and woman-centered childbirth or reduce birth disparities through educational, policy, and research projects. The Birth Trust is a grant-making fund where donors and birth activists commit a certain amount monthly and then vote and select which projects get funded. Since the Birth Trust launched in 2010, nine very diverse projects have been selected.
This legislation would alter the organization of and payment for maternity services by: creating a mechanism to deny Medicaid payment for elective deliveries before 39 weeks, bundling payment for the full episode of maternity care for low-risk women, enabling access to midwives and birth centers providing high-quality, high-value care, and developing standards and a certification process for “pregnancy care homes”
The Louisiana Birth Outcomes Project is a state-wide effort coordinated by the Department of Health and Hospitals. This multi-stakeholder initiative drew inspiration from the Transforming Maternity Care project and charged several interdisciplinary task forces with constituencies modeled after the five TMC stakeholder workgroups to determine critical steps for progress in four major areas: quality and safety, interconception care, behavioral health, and performance measurement.
Grant funds were acquired to implement a doula program for Crittenden Regional Hospital, a rural hospital in Arkansas. Trainings were established to train lay women to work in the program. Trainings were also provided for healthcare professionals to introduce gentle birth practices, and the role of a doula, and doulas working as part of the health care team.
This act addresses many of the recommendations put forth in the direction-setting Blueprint for Action, with provisions related to many of the Blueprint’s 11 focal areas, including performance measurement and leveraging of results; payment reform aligning incentives with quality; scope of covered services for maternity care; coordination of maternity care across time, settings, and disciplines; decision-making and consumer choice; and development and use of health information technology.
When 2 CNMs were fired from a private practice in our town, 80 pregnant women were suddenly left without the care provider of their choice. We set out to change a policy at our local hospital that required the ‘backing’ physician to be on-site while a CNM was with her patient.