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PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy. Tina Johnson, CNM, MS American College of Nurse-Midwives. Goals of ACNM’s Normal Birth Initiative. Promote healthy, normal physiologic birth as the standard of care for “low risk” women

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Promoting normal physiologic birth developing a national strategy

PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy

Tina Johnson, CNM, MS

American College of Nurse-Midwives


Goals of acnm s normal birth initiative
Goals 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


Cultural context of birth in the us
Cultural Context of Birth in the US

  • Prenatal 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


Reality of birth in the us
Reality of Birth in the US

  • Induction (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


Context of “Normal Birth”

  • Highly 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.



Formation of the physiologic birth task force
Formation of the Physiologic Birth Task Force

Consensus

Statement

Sub-Committees

Advisory

Committee

Steering Committee


Promoting normal physiologic birth developing a consumer statement about normal physiologic birth

PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Consumer Statement about Normal Physiologic Birth


Normal birth consumer statement
Normal Birth Consumer Statement

  • Women have lost confidence in their ability to give birth under their own power

  • Standard maternity care is not evidence-based and actually increases risk

  • Provides evidence based information to consumers about labor and birth

  • Increase women’s understanding of normal birth



PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing Documents to Introduce Normal Birth to Hospital Quality Personnel and Insurers


Quality patient care in labor and delivery: A call to action. J Midwifery Womens Health. 2012;57(2):112-113.


Joint commission perinatal care pc core measure set

PC-01 Elective Delivery action. J Midwifery

PC-02 Cesarean Section

PC-03 Antenatal Steroids

PC-04 Health Care-Associated Bloodstream Infections in Newborns

PC-05 Exclusive Breast Milk Feeding

Joint Commission: Perinatal Care (PC) Core Measure Set

Improvable with Physiologic Care


To date
To Date… action. J Midwifery

  • White paper about normal birth being submitted for publication

  • Documents targeting hospital quality personnel and insurers are in final stages of development and design


Promoting normal physiologic birth developing a tool kit for maternity care professionals

PROMOTING NORMAL, PHYSIOLOGIC BIRTH: action. J Midwifery Developing a Tool Kit for Maternity Care Professionals


Target: action. J Midwifery 1) Clinicians and hospital staff at the point of care 2) Maternity unit leadership

Scope: Implement care process improvements that support, promote, and facilitate physiologic birth through dissemination of useful, actionable resources and case studies from exemplars


Development of the tool kit
Development of the Tool Kit action. J Midwifery

  • 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


Birthtools menu of change
BirthTOOLS action. J Midwifery :Menu of Change

  • For each focal area, the toolkit will include:

    • Review of evidence

    • Model unit policies

    • Clinical decision support tools (e.g. algorithms, checklists)

    • Guidelines and tools for auditing performance

    • Educational resources for clinicians and/or consumers


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