Effective April 2010, Joint Commission has established a new set of perinatal quality measures which include the number of elective deliveries (both vaginal and cesarean) performed before 39 completed weeks gestation; cesarean rate for low-risk first birth women; and the number of women exclusively breastfeeding at hospital discharge. These new measures are based on measures endorsed by the National Quality Forum (NQF). Hospitals will want to minimize the number of elective deliveries performed before 39 weeks and the cesarean rate for low-risk first birth women, and to maximize the number of women exclusively breastfeeding at discharge. How will these new quality measures affect childbirth education?
Elective Deliveries Before 39 Completed Weeks Gestation
Childbirth class curriculums will need to include content about the risks to both mother and baby with elective delivery before 39 weeks. At the 2008 Lamaze International Conference, noted researcher Dr. Kathleen Rice Simpson and Gloria Newman presented the results of a study to test an educational intervention regarding the risks and benefits of elective labor induction in the context of prepared childbirth classes. They found that information based on current evidence and recommendations from professional organizations regarding risks and benefits of elective labor induction was beneficial in discouraging some women from choosing elective induction. We at the Family Way will let you know on this blog as soon as the Rice & Newman study is published. In the meantime, educators should develop strategies to effectively communicate information about the risks of elective induction in their classes. A nice handout and video on the benefits of allowing labor to begin on its own are available at no charge from Lamaze International and inJoy Videos.
Cesarean Rate for Low-Risk First Time Mothers
Childbirth educators are experts on strategies which reduce the risk for cesarean delivery for low-risk women. Encouraging women to stay at home in early labor, encouraging upright positions and movement during labor, encouraging a plan for continuous support which may include a doula, and providing information about non-drug methods of pain relief and physiological pushing all help to reduce the risk for cesarean surgery. Unfortunately, there are a few hospital administrators and some physicians who are not concerned about the skyrocketing cesarean rate. Having the Joint Commission require reporting of the cesarean rate for low-risk first time mothers sends a powerful message that hospitals, health care providers, nurses, and childbirth educators should all work together to reduce the cesarean rate for these women.
Exclusive Breastfeeding at Discharge
A recent study published in the American Journal of Public Health looked at hospital practices that help or hinder women who plan to exclusively breastfeed. Breastfeeding success is affected by what happens in the first hours and days after birth. Childbirth educators who teach in hospitals can work with other health professionals in the hospital to develop policies which support, rather than hinder, exclusive breastfeeding. Placing the baby skin-to-skin on the mother’s chest immediately after birth and keeping mom and baby together throughout the hospital stay promote breastfeeding success as well as eliminating supplemental feedings, pacifiers in the first 2 weeks after birth, and formula samples at discharge. Becoming “Baby-Friendly” will help a hospital to bring everyone on board to promote breastfeeding. Childbirth educators can also discuss the risks of formula-feeding in childbirth classes and help expectant parents to plan for breastfeeding support in the hospital and after birth. Again, Lamaze International and InJoy have a nice handout and video on the importance of keeping moms and babies together after birth.
April will be here before we know it! Childbirth educators need to jump onboard to help hospitals get ready for these new evidence-based , quality measures.
I stand behind my blog. I believe that childbirth educators play an important role in informing pregnant women and their partners about evidence-based strategies which do decrease the risk for cesarean birth such as:1) Letting labor begin on its own (avoiding induction; 2) Having continuous support throughout labor; 3) Staying home in early labor 4) Trying nonpharmacological pain management strategies before choosing epidural, etc.
How many women who do not take classes know that induction doubles the risk for cesarean for the first-time woman?
In addition to these evidence-based strategies, good childbirth classes give students the opportunity to explore their fears about labor and birth and build confidence.
Good childbirth classes are positive and confidence-building. They do not rely on scare tactics. They focus on strategies that promote safe and healthy birth; they also include information on cesarean surgery to reduce fear about cesareans in case surgery is needed.
All members of the health care team (health care providers, nurses, educators, doulas) have an important role to play in reducing our sky-high cesarean rate. In the June issue of Obstetrics and Gynecology, one of the editorialists warned that we may be more concerned with accretas and other complications of multiples cesareans if we don’t do something about the too-high primary cesarean rate. We all have a role to play.
Please do not misinform readers that “Childbirth educators are experts on strategies which reduce the risk for cesarean delivery for low-risk women”. These educators do not have (in most cases) adequate knowledge or “powers” that can reduce the risk for cesarean deliveries. In fact -most women that we see coming into our L&D units have been guilted to the Nth degree about not having a c-section and then we they do for unforseen reasons (ie: fetal intolerance to labor, etc) these poor women feel as though they have somehow failed. Quite a diservice to women if you ask the real experts with practice based knowledge who have more hands on experience than your so called educators. Please stop scaring women.