Making dreams a reality: Childbirth Connection’s roadmap to better maternity care

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Making dreams a reality: Childbirth Connection’s roadmap to better maternity care

The Centers for Disease Control (CDC) reported this week that the U.S. Cesarean section delivery rate rose for the 12th year in a row in 2008, to 32.3% of all births. The World Health Organization has recommended since 1985 that C-section rates be maintained between 5% and 10% as this range carries the best overall maternal and infant outcomes. Additional research in the past 20 years supports WHO’s recommendation, finding that delivering more than 15% of mothers by C-section creates more health problems than it solves.

What would maternity care in the U.S. look like if it conformed to evidence-based recommendations? What would it take to implement the models of care that research indicates are safest for mothers and babies? Childbirth Connection, a non-profit organization whose Executive Director Maureen Corry is featured in Orgasmic Birth and whose board Debra sits on, takes on these questions in two recent reports—the outcome of a two-year process involving professionals from every industry involved in U.S. maternity care.

The first report, “2020 Vision for a High-Quality, High-Value Maternity Care System,” sets goals for every level of maternity care from the direct care each woman receives to the “macro environment of care”—policymakers, insurers, regulators, accreditors, and litigators whose work indirectly impacts maternity care. The second report is a “Blueprint for Action” which breaks down “who needs to do what, to, for, and with whom to improve the quality of maternity care over the next 5 years.”

The reports find that for care to be both high-quality and high-value, it must be:

1. Woman-centered: respecting each woman’s values & culture, and promoting fully-informed decision-making shared between each woman and her caregivers;
2. Safe: reliable, appropriate, and coordinated between different providers;
3. Effective: based on sound evidence applied properly to each woman and minimizing overuse/underuse/misuse of care practices;
4. Timely: delivering information and services at the time they are needed and allowing maternal-fetal physiology to dictate all stages of labor unless medically contraindicated;
5. Efficient: using resources and technology appropriately and conservatively, and
6. Equitable: basing variations in care solely on the health needs and values of each woman and her baby.

Both reports call for a full range of safe birth settings to be made available to women, as well as support during delivery and the post-partum period. Coordination between providers must be improved and the cost for all services should be bundled into one payment covering the entire period running from pregnancy to six weeks postpartum. Practice patterns and views of caregivers and mothers regarding home birth, Vaginal Birth After Cesarean (VBAC), vaginal breech and twin birth, elective induction, and C-sections “on demand” should be aligned with best current evidence.

Support and education for caregivers, so that their work is satisfying and fulfilling, is an important element of improving outcomes. In particular, the liability system must be improved and supplemented by alternative systems that separate negligence and compensation, so that care providers’ decisions are not based on mitigating their risk of being sued but rather on the relevance of research findings to each client’s individual situation.

The Vision places emphasis on the need for local, state, and national performance measurements and transparent public reporting. It calls for more funding to research quality improvement in maternity care, the physiology of labor, disparities in outcomes of care, and long-term effects of health care treatments, nutrition, lifestyle, and environment during pregnancy. Most excitingly, it demands public engagement in determining research priorities.

If all this has put your head in a spin, perhaps the best summary of Childbirth Connection’s aspirations is this allegorical story in which two new mothers—one who received the most common model of care available in the U.S., and the other who received a model following best practices—share their pregnancy and birth experiences: “Two Birth Stories,”

Do you share Childbirth Connection’s Vision? How can we get the Blueprint into the hands of people who can implement its recommendations?

For more information, please see:

“Transforming Maternity Care: Direction-Setting Vision and Blueprint Reports,” Childbirth Connection,

“A Blueprint For High-Quality, High-Value Maternity Care,” WBUR, February 3, 2010,…

“Cesarean Section: Why Does the National U.S. Cesarean Section Rate Keep Going Up?” Childbirth Connection,

“Appropriate technology for birth.” Lancet. 1985 Aug 24;2(8452):436-7,

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