MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

March of Dimes: Empower Women, Decrease Disparities

Finishing my childbirth education certification means I can start combing through several maternal and infant health reports I’ve been collecting. What can I say? In addition to providing childbirth education, I like to read wonky reports.

First up is the March of Dimes’ December 2010 Toward Improving the Outcome of Pregnancy III (TIOP III). For the short version, check out this video clip and summary. TIOP III focuses on five themes or action items to improve overall quality of outcomes for the entire perinatal period (preconception, pregnancy, birth and postpartum):

1.       Pursue quality improvement and safety initiatives

2.       Decrease disparities, increase equity

3.       Empower women, encourage shared decision making

4.       Standardize regionalization of services

5.       Improve data collection

I know what you’re thinking. Won’t this report be more likely to collect dust on shelves across the land than affect real change? No, not necessarily. TIOP III hints at where maternal and infant care ought to be going in the next decade or so.

TIOP I (1976) and II (1993) continue to influence the delivery of motherbaby services today. The emergence of neonatal intensive care unit centers can be traced to the TIOP I recommendation that more of these resources be made available. Interestingly, TIOP III now suggests an oversupply of NICUs exist today relative to total annual births. This oversupply has been described as playing an unfortunate role in the dangerous trend of non-medical inductions. The babies who are born too early to thrive outside the womb create an unnecessary demand for NICU care.

As a consumer advocate and childbirth educator, I especially like TIOP III’s first three objectives for improving overall care and outcomes. Here are a few thoughts on each…

Perinatal quality improvement and safety initiatives

TIOP III supports quality improvement efforts like those underway by The Joint Commission on Accreditation of Hospitals, the primary accrediting body for most health care facilities. The Joint Commission is now including new performance measurements for accreditation including tracking for elective delivery, cesarean section, and exclusive breastmilk feeding.

The decision by The Joint Commission, an influential and powerful organization, to monitor infant feeding, no doubt, plays a role locally. Sacred Heart Medical Center plans to pursue the Baby Friendly designation for evidence-based infant feeding.

Pursuit of this designation is an important development for mothers, babies and the community because facility-based practices play a critical role in supporting families to initiate, establish and maintain exclusive breastfeeding after they leave the hospital or birth center. I’ve posted extensively on the importance of local hospitals becoming designated Baby Friendly providers of evidence-based infant feeding care.

Decrease disparities, increase equity

Addressing disparities in access to perinatal services is of critical importance to local families and communities. Lane County’s fetal-infant mortality rates are the highest in the state (among the highest in the nation?). Maternal and infant mortality are long-accepted markers for community wellbeing and potential. Lane County outcomes for all demographic groups lag. While lack of healthcare access is a problem throughout Oregon, our fetal-infant mortality rate means local communities suffer even more than similar communities from disparities in access and a lack of general healthcare equity. That Lane County is also home to the University of Oregon and Sacred Heart Medical Center, a major regional hospital, is incredible. Sadly, and despite the efforts of the Healthy Babies, Healthy Communities coalition, there has been an impressive lack of civic leadership / engagement devoted to closing these gaps.

Empowering women and families for full partnership with providers and shared decision-making

TIOP III provides organizations and individuals committed to excellent motherbaby outcomes with an updated mission statement:

Empowering women and families with information to enable the development of full partnerships between health care providers and patients and shared decision-making in perinatal care

These are more than nice words. They describe practices that are increasingly associated with desirable outcomes. Here’s what TIOP III goes on to say:

… evidence-based practices — CenteringPregnancy®, Kangaroo Care and exclusive breastmilk feeding — have been shown to improve perinatal health outcomes by empowering patients: positioning them, their newborns and their families at the center of their care and making them an integral part of their health care decision making team.

The PeaceHealth Nurse Midwifery Birth Center is the only Lane County provider of Centering Pregnancy. It is a recipient of March of Dimes funding for this evidence-based prenatal care.

Looking to the future, TIOP III goes on to acknowledge the Institute for Healthcare Improvement for being on the right track where empowerment and decision making are concerned. IHI develops various care models to describe the future direction of healthcare excellence – its perinatal model of the future puts women and families at the center of future care structures as the source of control – IHI’s ideal model of perinatal care. As a childbirth educator and motherbaby advocate, I am fully on board with this!

That’s all for now…..

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