PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy

1. PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy Tina Johnson, CNM, MS American College of Nurse-Midwives

2. 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

3. 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

4. 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

5. 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.

6. A shared culture of dialogue, collaboration, and teamwork

7. Formation of the Physiologic Birth Task Force Consensus Statement Sub-Committees Advisory Committee Steering Committee

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

9. 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

11. Endorsers

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

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

15. 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 Joint Commission: Perinatal Care (PC) Core Measure Set Improvable with Physiologic Care

16. To 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

17. PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Tool Kit for Maternity Care Professionals

18. Target: 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

19. Development 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

20. BirthTOOLS: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