The United States is failing women and infants.
Maternal and newborn health outcomes are worse than in other high-income nations, costs are high and many women cannot access safe, evidence-based maternity care that truly reflects their needs and preferences. The good news is that well-tested, evidence-informed strategies can address these abysmal outcomes and transform the health care system into one that protects and promotes the health and well-being of mothers and babies. That is the key takeaway from a new, comprehensive report, Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing, authored by 17 national maternity experts and released by the National Partnership for Women & Families. The Blueprint details six strategies to advance high-value maternity care by promoting, supporting and protecting women’s innate capacity for healthy childbearing and by safely limiting use of consequential interventions around the time of birth.
You know how dear improving maternity care is to me.
What you may not know is that I was a board member of Childbirth Connection for many years. Part of dedicating my life to improving birth is to serve people in every way possible, from providing services, education and volunteering my time to serve on boards to add my voice and support initiatives that will improve care and people’s lives and births. I am so proud of the ongoing work of Childbirth Connection and the Partnership for Women is doing.
The time is now! Please make a tea and make the time to read this important Blueprint.
The Blueprint has the potential to improve care and outcomes for all women and newborns, including lower-risk women and newborns that all-too-often receive unnecessary procedure-intensive care and those who need specialized care and will benefit from healthy perinatal physiologic processes such as early skin-to-skin and breastfeeding after cesarean, whenever possible. The Blueprint is relevant to a wide-range of stakeholders responsible for maternal and infant health, including policymakers, clinicians, administrators, health plans, employers, researchers, birth workers, advocates and women and families themselves. While the Blueprint was developed for the United States, much applies to many other settings.
Each of the six strategies in the Blueprint offers priority recommendations with action steps and many timely references to support positions taken, provide more information and help with implementation. The six strategies are:
- Reward health care providers and systems that deliver quality, woman-centered maternity care. Through innovation in how we pay for and deliver maternity care, health care leaders can improve the quality and lower the cost of this care by minimizing both overuse and underuse and encouraging the adoption of high-performing elements of maternity care – such as continuous labor support and breastfeeding support.
- Prioritize measuring – and reporting on – the quality of maternity care. Performance measurement experts and decision-makers should fill gaps in standardized performance measures and make good use of available measures to enable providers, women and others to obtain and use quality information.
- Meaningfully engage women and families in maternity care. Consistent, widespread use of shared care planning and shared decision-making, among other tools, would help ensure that women and families are at the center of – and fully engaged in – efforts to improve maternity care.
- Change how we educate the maternity care workforce. All levels of education should support maternity care clinicians in shared knowledge and skills for physiologic childbearing, effective team-based care and shared decision-making.
- Build up the maternity care workforce. To address the growing shortage of maternity care providers in United States and better meet the needs of an increasingly diverse population of childbearing women, we need to better retain and deploy physicians, increase use of midwives and build a workforce that better reflects the diversity of childbearing families.
- Prioritize and support research to advance the science of physiologic childbearing and its effect on maternal and child health. Research on perinatal physiology, clinical epidemiology and implementation science is critical for driving meaningful improvements in maternity care and strengthening maternity care policies, programs and services.
It’s especially exciting and important that the Blueprint includes numerous references throughout on the critical role of doulas in fostering physiologic birth. Strategy 1 explicitly calls for expanding access and reimbursement for high performing elements of maternity care, including doulas, midwives, birth centers, and community health workers to advance high value care. Strategy 3 of the Blueprint focuses on creating a maternity care system in which childbearing women and families meaningfully engage in their care from pregnancy through labor and birth, and the postpartum and newborn period. Recommendations focus on establishing system enhancements to support women, expanding communication and education that empower women to understand, value and seek physiologic care, and implementing effective birth preferences care plans and integrating shared decision making into the maternity care system to support informed decision making. Other recommendations are long overdue. These include insuring that all maternity professional students experience physiologic labor and birth and expanding maternity safety courses, simulations and other initiatives to include preventive upstream physiologic care.
I encourage you to read the Blueprint and identify recommendations that you, your colleagues, clients, etc.. Please share widely via social media, list servs, blogs, commentaries and other channels. Together, we can create a maternity care system that will reliably offer the care women and families need and deserve. Read the full report here.
Learn your options, create your birth preferences, discover how pleasure is an essential tool in creating a natural physiologic birth. Re-empower yourself so you are ready to raise your voice and have a safe, satisfying gentle birth for you and your baby!