Developing a National Strategy Tina Johnson CNM MS American College of NurseMidwives Goals of ACNMs Normal Birth Initiative Promote healthy normal physiologic birth as the standard of care for low risk women ID: 908651
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PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy
Tina Johnson, CNM, MS
American College of
Nurse-Midwives
Slide2Goals of ACNM’s Normal Birth Initiative
Promote healthy, normal physiologic birth as the standard of care for “low risk” women
Identify the evidence, care processes and outcomes, quality indicators, systems changes, and outreach needed to support and promote the value of healthy, spontaneous labor and birth within the healthcare system and to the general public
Slide3Prenatal care that “Expects Trouble”“Safety” is ensured if birth takes place in hospitals with an obstetrician
“Intervention intensive” labor and birth is best
Fear of litigation
Intense fear of labor and birth
Rising maternal mortality and cesarean rates
Cultural Context of Birth in the US
Slide4Induction (41%)/Augmentation (31%)Intravenous fluids (62%)
EFM (94% continuously in 2006)
Restrictions movement (57%), eating (79%) drinking (60%)
Epidural (67% of vaginal births)
Urinary catheter (47%)
Instrument delivery (11%)/episiotomy (17%)
Cesarean (31%) Listening to Mothers III (2013) www.childbirthconnection.org
Reality of Birth in the US
Slide5Highly technological procedures in childbirth have been normalized
without
an associated improvement in outcomes.
Many different countries have created statements defining and describing
“
normal” birth, yet at that time, the U.S. did not have a similar, consensus-driven statement about this fundamental concept in birth.
Context of “Normal Birth”
Slide6A shared culture of dialogue, collaboration, and
teamwork
Slide7Formation of the Physiologic Birth Task Force
Consensus
Statement
Steering Committee
Advisory
Committee
Sub-Committees
Slide8PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Consumer Statement about Normal Physiologic Birth
Slide9Women have lost confidence in their ability to give birth under their own powerStandard maternity care is not evidence-based and actually increases risk
Provides
evidence based
information to consumers
about labor and birthIncrease
women’s understanding of normal
birthNormal Birth Consumer Statement
Slide10Slide11Endorsers
Slide12PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing Documents to Introduce Normal Birth to Hospital Quality Personnel and Insurers
Slide13Quality patient care in labor and delivery: A call to action. J Midwifery
Womens
Health. 2012;57(2):112-113.
Slide14Slide15Joint Commission: Perinatal Care (PC) Core Measure Set
PC-01 Elective Delivery
PC-02 Cesarean Section
PC-03 Antenatal Steroids
PC-04 Health Care-Associated Bloodstream Infections in Newborns
PC-05 Exclusive Breast Milk Feeding
Improvable with Physiologic Care
Slide16To Date…White paper about normal birth being submitted for publication
Documents targeting hospital quality personnel and insurers are in final stages of development and design
Slide17PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Tool Kit for Maternity Care Professionals
Slide18Target:
1) Clinicians and hospital staff at the point of care 2) Maternity unit leadership
Scope:
I
mplement care process improvements that support, promote, and facilitate physiologic birth
through dissemination of useful, actionable
resources and case studies from exemplars
Slide19Development of the Tool Kit
Founded on the Consensus Statement
Encouraged engagement vs. alienation
Whole scale change vs. steps at a time
Searchable
Easy access from a busy unit
Aimed at the front line user with background for administrators and systems
Slide20BirthTOOLS :
Menu
of Change
For each focal area, the toolkit will include:
R
eview of evidence
Model unit policiesClinical decision support tools (e.g. algorithms, checklists)Guidelines and tools for auditing performanceEducational resources for clinicians and/or consumers
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