Saturday, April 04, 2009

Transforming Maternity Care Part III

There has been much to write about related to last week's birth professional summit called Transforming Maternity Care , whose goal is to make evidence-based care the standard in America, the land where obstetrical practices -- even bad ones -- die hard in the hospital.

But one midwife stood to say that while the hours of discussion were riveting, the average mother-to-be does not even know there is a problem with maternity care.

Which is why we need a more effective communications campaign to reach them.

On my way back from the conference in DC to Boston, I shared a cab (and hours of delay at the airport) with Gene Declercq of BU's School of Public Health. I asked him, given the success of the breastfeeding campaign in recent decades, is there hope that similar tactics could be applied to a campaign to improve maternity care, so that women know what practices are truly good for them based on the evidence?

He was dubious, saying that with breastfeeding, the only stakeholders to truly oppose nursing were the formula companies and they needed to be subtle in their marketing.

With childbirth, a whole medical system -- one that is paid for performing procedures, many unnecesary and some even harmful -- is set up to keep the status quo.


He may be right, but as one speaker made clear, childbirth is still a sexy issue that gets people's attention. And with more than 4 million births a year in this country, there is a built in audience. Let's try to reach them.


publichealthdoula said...

I've been to so many meeting lately where all of our discussions boil down to the need for cultural change. When women see all birth as frightening and dangerous, all medical procedures as necessary and good, and people who say otherwise as "natural childbirth nazis", it's hard to make headway. How do we transform these attitudes?

I do my small part by showing friends and family "The Business of Being Born", telling them stories from my doula work, and encouraging them to question the standard of care. But that's not the large-scale change we need, and I'm not exactly sure how to do that. Show "The Business of Being Born" to everybody in high school? Make your book required reading? It's a tough question but more and more I think people are seeing education (along with health care reform) as a vital component.

mel817ski said...


I ditto everything written. Same as publichealthdoula, I have try to show BOBB to anyone who will watch! I try to speak out at work (I am an L&D nurse) and try to question outdated practices, blog about the crisis in maternity care and hope that pregnant women will stumble upon my blog, joined local BirthNetwork and ICAN groups to try to distribute information about VBAC and birth advocacy/choice to expectant mommas. But it all seems like too LITTLE!! I do like the idea about showing the BOBB in every highschool, haha! How about at freshman orientation in college too :) No but seriously, something BIG has got to happen, and I want to a be a part of it, but I don't know what "it" is!


pinky said...

I hate to be a downer. But this is what we tell each other around the hospital. Things will change. And they will change on a large scale when healthy Moms start dying in childbirth again.

Sad. But it does all add up. C-section is a reasonalby safe proceedure but not at fully dilated. And it is a reasonably safe proceedure but risk increases with number of c-sections you have had, amount of pitocin we have given you to try and induce you, etc etc....

One neonatologist told me there will always be a certain amount of babies that do not make it through the process be it at 9 weeks or 2 months of live. But Mothers in this society do not expect they are in any danger of losing their life. When more of that occurs, a big change will come. I hope I am wrong but I don't think I am.

pinky said...

I am not a big fan of BOBB. I think more women need middle of the road information. They want epidurals. They want pain relief. I think they should be able to get that. Problem with many childbirth educators is that they have an agenda. I wouldn't want a childbirth educator to tell me her opinion. I don't give a flying crap what her opinion is. If I was a birthing woman I want to know the options without judgement. I think BOBB has too much crunchiness to appeal to the community at large. Perhaps I should make a movie? The world of L&D according to PINKY! Just kidding.

publichealthdoula said...

Good point Pinky, but I think women in this country all already dying...we're just not hearing about it (or it's painted as a "freak occurrence" or flagrant and unusual malpractice). The Safe Motherhood Quilt Project is an attempt to call attention to the levels of maternal mortality in the U.S.

I like "Business of Being Born" because it's somewhat crunchy but SO much more mainstream than most natural birth movies out there. Yes, some women want pain relief, but I think part of the intense fixation on "getting my epidural in the parking lot" is just plain fear. I think movies like BOBB show that birth doesn't have to be a fearful, horrific experience. It's OK to get an epidural, but I don't think it's OK to be terrified of your baby's birth.

pinky said...

Yes, I would have to agree that absolute terror does no good in the birthing process.

Michelle said...

I am a mom of two (I had my second baby at a birthing center) and I have thought much about how to change the way we start our maternity care. It seems that women just go to to our ob/gyn because that is the person we already know. I think that young women need to know birth options before they learn that birth is "scary and dangerous" from the media, doctors and others. I'm not sure how it would work but if it started when girls are young teens?) and they saw healthy, natural birth they might be empowered to do the same later on.

Adirondack Autumn said...

The thing that upsets me most is that in many places the stats have gotten worse in the last 10 years! More inductions, more c-sections, more back door inductions...It doesn't HAVE to be this way. I had 3 normal deliveries in the hospital without epidurals and except for antibiotics for a questionable beta strep status, without interventions.

What happened to the WHO Mother-baby Friendly Hospital Initiative? What happened to the Healthy People Goals of less than a 20% c/s rate at community hospitals???

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