Birth, Birth Options, Maternal-Child Consumer Issues Consumer Health Birth, Birth Options, Maternal-Child Consumer Issues

Who are the consumers? *moms to be *dads fetuses *BEFORE pregnancy, if possible

What does “informed” mean, for this life stage? Best possible diet other “lifestyle choices” daily environment care, both pre-conception & prenatally understanding of risks/options misinformation/information environment what’s being out-and-out sold to consumers costs

More & more, it seems being informed means . . . . http://www.youtube.com/watch?v=_eQFJR8wM00

What’s the consumer’s responsibility? seek care, and consider your preconception life stages* as an opportunity to improve your health and become a smart consumer! *Whether or not you plan to become a parent or plan to become a parent again Guidance from the Centers for Disease Control and Prevention (CDC) around a “national plan” for improving preconception health and care in the United States http://www.cdc.gov/preconception/overview.html

What’s society’s responsibility? And what are we doing about it? Just exactly what should we all take responsibility for when it comes to bringing healthy babies into the world? Anything? Nothing? It’s all up to those who want to, or happen to, become pregnant or share in the process of someone else becoming pregnant? Agree or disagree, here are reports from a highly reputable national nonprofit organization, connecting health care reform to preconception/reproductive health. The third one down is a brief, readable summary of what the ACA (aka Obamacare, remember?) put in place and some “unexpected” or side-effect benefits of the contraception coverage requirement: http://www.guttmacher.org/pubs/gpr/15/4/gpr150418.html

What are the risks? Who’s most at risk? poor pre-conception health little/no/late prenatal care negative “lifestyle choices” ATOD* use/addiction poor/less than optimal diet risky workplaces unhealthy relationships interventional approach to birth induction episiotomy cesarean section VBAC bans *Alcohol, Tobacco, and Other Drugs

induction stimulating onset of labor rise from 9.5% in 1990 to 22%+ in 2009 –ACOG, 2009 induction means you “buy a package of intervention” as a result --Plumbo, 2009 risks increased fetal heart rate, shoulder/other problems NICU admission forceps, vacuum c-section prematurity, jaundice --Weiss, 2010

episiotomy 2006 – 9% nationally routine cutting to prevent tearing 1997 to 2005 – rates as high as 30% nationally much lower in many other countries important 2005 article recommended rates should drop 2006 – 9% nationally --Johnson, ACOG presentation, 2009 doesn’t improve outcomes; comes with many risks pain, postpartum pain healing issues, infection other damage/rare but serious complications, both for mom & baby --Wooley, 1995

Cesarean section most common surgical procedure in America 2007, national rates up to 31.8% --CDC, 2009 WHO recommends 15%; rates are different based on hospital policies, practices NOT on health! –CIMS, 2009 http://www.thebirthsurvey.com/AboutProject.html situation in WA 11,000 unneeded each year (still lower than US) plan to equalize payment for vaginal & C-section – McConnell, 2009

VBAC http://www.cbsnews.com/video/watch/?id=62922 98n

More on Wa birth environment Midwifery legal in Washington state, 2 paths: “licensed” and Certified Nurse- Midwives (also licensed by WA) covered by all insurance companies in WA state, varies by plan 2008 report analyzing Medicaid and private insurance claims shows cost savings to Wa’s health care system of nearly $3 million biennially Wa state law (unlike most other states with licensing option) allows Medicaid patients to use midwives, and rates mirror all Medicaid births Medicaid-covered women receiving midwifery prenatal care are ~ 1/2 as likely to have a c-section as those with another type of provider http://www.washingtonmidwives.org/ Childbirth centers licensed by DOH; low-risk births only Medicaid friendly http://apps.leg.wa.gov/WAC/default.aspx?cite=182-533-0400

Evidence-based maternity care Evidence-based = a lot of strong scientific literature provides support for something (showing safety & effectiveness) Evidence shows too much use of: epidurals – minor to major risks, both mom & baby continuous electronic fetal monitoring – risks to pelvic floor because of more use of forceps/vacuum rupturing membranes – more c-section episiotomy

Evidence-based maternity care Evidence shows too little use of: smoking cessation support prenatal vitamins labor support non-supine positions hands-to-belly maneuvers of fetal position cutting cord later skin-to-skin contact support for breastfeeding – esp to help w/postpartum issues

Barriers to evidence-based care no measurement tools so we aren’t measuring, reporting, rewarding, and improving payment systems out of sync w/evidence* malpractice system effects use of specialists for healthy, low-risk populations not using evidence in setting professional guidelines lack of attn to harm and iatrogenesis how to translate research (evidence) into practice industry pressure uninformed consent/women’s lack of preparation focus in media and popular discourse *hospital charges for current birth care are the highest of ALL hospital conditions!

How to help practice match evidence EDUCATE stakeholders support more research reform the payment system – involve state, federal, & private REQUIRE measurement, reporting, and improvement All info on Evidence base slides taken from Sakala & Corry, 2008