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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

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, consensusdriven statement about this fundamental concept in birth. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

A shared culture of dialogue, collaboration, and teamwork Copyright © 2013 American College of

Formation of the Physiologic Birth Task Force Consensus Statement Sub. Committees Steering Committee Copyright

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

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

Endorsers Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing Documents to Introduce Normal Birth to Hospital Quality Personnel and Insurers Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

Quality patient care in labor and delivery: A call to action. J Midwifery Womens

NQF JC Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved •

Joint 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 • • Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Improvable with Physiologic Care

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Tool Kit for Maternity Care Professionals Copyright ©

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

Birth. TOOLS : 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 Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved