Give the Gift of Knowledge

One step that pregnant women can take towards making sure their care provider is familiar with the latest evidence-based maternity practices is to give their doctor or midwife a copy of the book “Optimal Care in Childbirth,” by Henci Goer and Amy Romano.  Every maternity care provider should read this book, and keep it handy as a reference.  Women might want to keep a copy for themselves too.  Giving this book to your doctor or midwife sends a strong message that you value and expect to receive evidence-based maternity care and that you are savvy enough and motivated enough to seek out the evidence basis of their practice.

This book is not an easy read, nor is it intended as a reference for expectant women.  Instead of “what to expect…” this book is full of detailed scientific evidence about the care birthing women should be given and uses the physiologic, or normal natural physical process, of birth as the basis of care.  Authored by a medical writer and acknowledged expert in evidence-based maternity care and a research expert/midwife, “Optimal Care in Childbirth” gives thorough analyses of current medical maternity practices and the evidence that supports or refutes their use.  It also provides strategies for optimal care and mini-reviews of the evidence, and leaves no stone unturned with respect to the scientific basis for cesarean surgery, induction of labor, augmentation of labor, positioning for labor and birth, care after birth, newborn practices, and more.

I have heard doctors and midwives complain that it is hard to keep up with the research because they are so busy delivering babies.  I have also seen that “silos” exist, where doctors only read journals in their specialty, and miss out on the research that is conducted in related fields, such as midwifery, nursing, and childbirth education.  This book captures research from many sources and packages it in a manner that is portable and easy to share with others.  The mini-reviews provide quick reference points for decision-making in non-emergency situations.

The book costs $50, and by giving it as a gift to your doctor or midwife the message it sends is priceless:  receiving evidence-based maternity care matters to you and you are willing to invest your time and your money in order to get it.

Do they already have a copy?  Suggest they re-gift it to another doctor or midwife in the practice, or to the nurse’s station on the labor and delivery floor of the hospital, or to a nurse, or a hospital administrator, or…

 

Goer, H. and Romano, A. (2012). Opimal Care In Childbirth:  The Case For a Physiologic Approach. Seattle, WA: Classic Day Publishing.

Available on Amazon.com

This is an unsolicited review and I receive no compensation for posting it.

Book Review: Cut, Stapled, & Mended: When One Woman Reclaimed Her Body and Gave Birth On Her Own Terms After Cesarean

Cut, Stapled, & Mended:  When One Woman Reclaimed Her Body and Gave Birth On Her Own Terms After Cesarean by Roanna Rosewood

©2013 by Roanna Rosewood.

Cut, Stapled, & Mended tells the story of Roanna Rosewood’s journey to motherhood and how the births of her three children changed her life.  Fiercely independent, emotionally detached from her painful childhood, and with rebelliousness against modern medical treatment instilled in her by her holistically minded divorced parents, she faces the birth of her first child with the self-assuredness of a proud warrior as yet untested in battle.  When her planned home birth goes awry because her water breaks but labor does not start, she finds herself in the midst of a hospital birth overseen by an unknown doctor who is not supportive of Roanna’s efforts for a natural birth and on the hospital’s timeclock to force her slow labor to speed up.  Exhausted and overwhelmed, Roanna consents to a cesarean delivery.  Roanna is tied down to a surgical table, and when her son is born and screaming at his entrance into the world, she is unable to go to him, to comfort him, or even caress him.  She begins her journey to motherhood feeling like a failure.  Her body feels broken and scarred, and visions of the surgery replay in her mind while she believes that the first experience her son has had in life is one of abandonment.

When Roanna is pregnant a second time, she pursues every alternative therapy she can find that might heal her body to help her have a vaginal birth.  When this pregnancy ends in a cesarean birth as well, the doctor informs her that she had dense scar tissue, called adhesions, growing throughout her abdomen and her uterus actually tore during the birth.  She refuses her midwife’s attempts to process through the birth experience, instead choosing numbness and a grim acceptance of her belief that she is not strong enough to bring life into the world.

During her third pregnancy, Roanna takes the opportunity to go on the trip of a lifetime to Hawaii.  While away from daily life, she is able to reimagine herself as different person and mentally process through many of her life experiences and her beliefs about herself, her relationships, and her needs.  She is able to connect with some core truths, and strip away some of the armor that has shielded her emotionally since she was a child.  Finally, she is able to have an unmedicated vaginal birth.  But, even that experience, which she has dreamed about and fought for tirelessly for years, leaves her with feelings that are completely unexpected.

Birth stories teach a number of important lessons to everyone who is involved in birth.  Women who will give birth need to hear them in order to learn more about what to expect.  Men who will be fathers need to hear them to better understand how birth transforms their partners into mothers.  Doctors, midwives, nurses, other caregivers, and hospital administrators need to hear the stories of the women they work with to hear firsthand the effects of the care they give on the women they care for.  While each birth story is as unique as the woman who is telling her story, there are themes and similarities that one can identify after hearing many of them.  Ms. Rosewood’s birth stories share similarities to many other birth stories which can act as guides to help improve birth in our country.

Ms. Rosewood eloquently speaks about the physical and emotional effects of cesarean surgery on women as they enter into motherhood.  She writes about the desire for a VBAC (vaginal birth after cesarean) which many women wish for but few achieve in this country.  She writes with refreshing honesty about the surprising nature of birth and how even a seemingly “perfect” birth demands to be processed emotionally and integrated into a women’s life.  In my opinion, the value and the beauty of this book are the depth of description and the honesty about the emotional components of Ms. Rosewood’s journeys through birth because few women give voice with such clarity to this side of the experience.  The emotional truths she describes are her own, and they are similar to the truths of thousands of other women.

Birth in this country is treated as a medical condition to be managed, not as the rite of passage which contains physical, psychological, and emotional components that all must be addressed.   The mind plays a vital role before, during, and after birth.  Cut, Stapled, & Mended thoughtfully explores the side of birth that is often ignored, and in doing so highlights both the damage and the growth that can occur during any kind of birth.

The Corporate Cut

How many cesarean sections does your corporate insurance plan pay for in a year?  If you work in an industry unrelated to maternity care, you may not think to ask this question – but you should.  Why?  Because the current cesarean rate in the U.S. today is over 30%, even though the World Health Organization estimates that 15% is the optimal rate for balancing the risks of this major surgery against the benefits. If your business were to achieve half the national rate (i.e. the optimal rate of 15%) it could save your company thousands, if not millions of dollars a year.

“The Cost of Having a Baby in the United States,” a recent report released in January 2013 by Childbirth Connection, states that maternity costs in the US have risen by 50% since 2004 and the “average total Commercial insurer payments for all maternal and newborn care with vaginal and cesarean childbirths were $18,329 and $27,866, respectively.”    By avoiding one employee’s cesarean section a year a small company could save more than $9,500.  Ten cesareans avoided saves $95,000, and 100 unnecessary cesareans averted by a corporation that currently pays for 350 births annually saves almost one million dollars in a year.

You may be thinking that cesarean surgery is necessary to save the lives of either the mothers or the babies who experience this type of birth.  It is true that cesarean, also called C-section, is a life-saving technique.  However, they are considered by many experts to be overused.  Our nation’s rising maternal death rates, which already put us at the bottom of the barrel compared with other industrialized nations, show that our high rate of C-section is not providing the lifesaving outcomes we desire from such a costly intervention.

Furthermore, a recent study released by the American Academy of Birth Centers shows that ”women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean birth compared to women who give birth at hospitals.”  In fact, the cesarean rates for women transferred to hospitals from birth centers was 6%.  This shows that is possible for our maternity care system to do better.

Reforming our maternity care system is a David vs. Goliath fight.  Reform-minded underdogs such as midwives and consumer advocates who are armed with scientific and qualitative evidence and cost-saving practices are coming up against well-funded entrenched stakeholders like hospitals, medical societies, and insurance companies that are fighting to keep the status-quo to protect their bottom line.  Savvy businesses will recognize that because they are commercial insurers of their employees they already have a horse in this race.  It is time for corporations to learn about maternity care, the same way they have about other wellness issues and chronic illness control for their employees, to help bring about changes that will improve outcomes and save lives, and also save our nation billions of healthcare dollars in the process.

The first step for businesses to take to ensure they can realize cost savings in maternity care is to flex their economic muscles and let insurers, hospitals, and medical societies know that lowering the cesarean rate is a priority for your business.  Purchases of insurance products, benefits, and wellness packages should reflect that priority.  If the adequate products don’t yet exist, corporations can demand that they be created.  Healthcare improvement collaboratives can help smaller businesses leverage their power to demand these types of products.  Corporate gifts and grants to hospitals can come with the caveat that the hospital show annual progress in reducing their cesarean rates toward the 15% mark and poor results=no more money.  Push back against organizations that lobby for non-evidence-based care practices, the exclusion of birth centers, and the limiting of the practice of midwives as care providers.  Ensuring access at the state and national levels to birth centers and midwives for care will be an important pathway to economic savings in the coming years.

What can your company do to help employees reduce their chance of having a cesarean birth?

(Truven Health Analytics, Childbirth Connection, Catalyst for Payment Reform, Center for Healthcare Quality and Payment Reform, 2013)

(Susan Rutledge Stapleton CNM, 2013)

Why Corporations Should Put Midwifery Bills on Their Legislative Watch

How easily can the women you cover with your benefits packages access low-cost, low intervention maternity care?  There is a lot of discussion around the internet these days about how the use of midwives and birth centers could save the government billions of dollars because it pays for almost half the births in this country through Medicaid.  Who pays for the other half of the births in the country?  American businesses, through their employee benefits packages.  The style of care that midwives in birth centers and out-of-hospital provide is low-intervention and lower cost, is beneficial for the majority of women giving birth, most of whom are considered at low risk for problems with their pregnancies, and leads to better outcomes with less morbidity.  That’s great, but if women can’t access it, then it doesn’t lead to cost savings.  Women can’t access midwifery care if state legislation does not support it.

In order to see the cost and performance benefits of midwifery care, out-of-hospital midwifery and birth center regulations, along with payment structures, must be aligned with the goal of providing widespread access.  These state-level regulations are set through legislation.  Every state has a different set of rules dictating what type of licensure midwives must have, how birth centers must function – if they are allowed at all, and whether or not payment is required through Medicaid or Medicare and private insurance.

The ideal legislation would:

• Set clear guidelines for who may legally practice as a midwife out-of-hospital, and include all the pathways for licensure, including Certified Nurse Midwives, Certified Professional Midwives, Certified Midwives, and Licensed Midwives
• Allow midwives who practice out-of-hospital to be regulated by midwifery boards, not medical boards and have no requirement for written collaborative practice agreements with obstetricians
• Allow independent birth centers to operate unencumbered by onerous rules
• Require that all types of licensed midwives be reimbursed by Medicaid, and also private insurance
• Provide adequate funding and appropriate regulation of the educational system in order to train more midwives

26 states currently have legislation that regulates out-of-hospital midwifery.   10 states outlaw direct-entry midwifery, and 14 states have ambiguous regulations or licensure is unavailable.   82% of states have regulations regarding birth centers, and it is important to know if those regulations in your state favor them or not.  There are also regular pushes by medical trade groups, hospital organizations, and medical boards to alter legislation to favor hospital birth in order to maintain market share.  There is a lot of money at stake when it comes to maternity care, and hospitals and doctors are reluctant to allow the competition that midwifery creates in the marketplace.

If legislation doesn’t align to provide your employees with access to midwifery and birth center maternity care, your business will continue to pay top dollar.