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

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

3. 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

4. More & more, it seems being informed means . . . .

5. 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

6. 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:

7. 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

8. 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

9. 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

10. 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
situation in WA
11,000 unneeded each year (still lower than US)
plan to equalize payment for vaginal & C-section – McConnell, 2009

11. VBAC
98n

12. 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
Childbirth centers
licensed by DOH; low-risk births only
Medicaid friendly

13. 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

14. 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

15. 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!

16. 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