MotherBaby Network

advocacy and commentary with a focus on Lane County, Oregon

Category Archives: health care access

Cesarean Awareness Month – April 2012

For the first time in 14 years, the 2010 US C-section rate of 32.8% is down slightly from the 2009 rate of 32.9%. This is excellent news but it is too early to celebrate. A quick look at the US Cesarean Rates from 1970 to 2010 depicts the long history of a negative trend. It will take some time to bend it positively.

How does Oregon compare with other states?

For years, cesarean section rates in Oregon hospitals and counties have far exceeded the 15% limit recommended by the World Health Organization. Oregon Public Health Authority (OPHA) data for 2011 indicates a state rate of 28.94% – down slightly from 29.45% in 2010. Unfortunately, Lane County’s Sacred Heart Medical Center RiverBend (35.18%) and McKenzie-Willamette Medical Center (29.71%) are above the state average and well beyond recommended rates.

The State of Oregon proclaims April Cesarean Awareness Month.

State of Oregon Proclamation: April is Cesarean Awareness Month

OPHA collects birth certificate statistics for vaginal, VBAC and cesarean section deliveries by county, facility and out of hospital settings. Cesarean sections resulting from birth center, home birth or inter-hospital transfer are not disaggregated. Using 2011 data, the following tables were created by MotherBaby Network. Download the OPHA document

Tables for Oregon 2011 using OPHA Data (download tables)

  1. Hospital Rates for –C-Section and VBAC
  2. C-Sec and VBAC Rates for Hospitals with more than 1000 births
  3. County C-Sec Rates
  4. County Out-of-Hospitals Births (Birth Center and Planned Home Births)
  5. Lane County Vaginal, VBAC and C-Sec Rates by Facility

Cesarean section can be a lifesaving technique for both mother and infant. When practiced in the absence of medical benefits, however, the risks outweigh the benefits of vaginal birth. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased maternal mortality.

The California Maternal Quality Care Collaborative (CMQCC) recently published a comprehensive White Paper on the state’s cesarean section rates. In addition to confirming higher costs and more complications for mothers and babies, the paper reports growing evidence of greater psychological distress and illness including postpartum anxiety, depression, and post-traumatic stress disorder associated with cesarean birth as compared to vaginal.

…the widespread over-use of maternity procedures including Cesarean sections and scheduled inductions, which credible evidence tells us are beneficial only in limited situations, has resulted in longer maternity hospital stays and multiple costly procedures…sadly, despite our exorbitant expenditures on maternity care, childbirth continues to carry significant risks for mothers and babies, especially in communities of color.
– Congresswoman Lucille Roybal-Allard

To stop exposing women and babies to cesarean risk in the absence of real medical benefit, the multiple perverse incentives driving its misuse must be addressed. Provider convenience and changes in obstetric practice, misguided insurance policies, defensive medicine and financial incentives are a few needing correction. Debunking the myths of maternal request for cesarean section is also important.

Although there are undoubtedly some women who do seek elective Caesareans, they are hardly enough to increase the number of Caesareans by 400,000 nationally since 1996.
Declercq & Norsigian

As cesarean section rates increased by sixty percent over the past 15 years, access to VBAC (vaginal birth after cesarean) has diminished. In 2008, less than 13% of Oregon births after cesarean were vaginal. Most women have no choice but to have a repeat cesarean. Despite the lack of choice, this is called “elective” surgery.

Wondering if your hospital allows or bans VBAC? Find out at cesareanrates.com.

Barring women from VBAC drives today’s cesarean section epidemic by fulfilling the prophecy “once a cesarean, always a cesarean.” Interestingly, this saying was originally uttered as a precaution against over use. A cursory look at Childbirth Connection’s graph of 1989 -2010 federal data for primary, elective and VBAC births shows the down-ward trend of VBAC reflecting its absence as a choice in the reproductive lives of women. Seeking to correct this barrier, the National Institutes of Health and the American Congress of Obstetricians and Gynecologists have both recently taken positions supporting VBAC as a safe option for most women.

 “… needless cesarean sections are actually harming women and babies alike. California Watch found that hemorrhaging from C-sections “is one of several possible factors in the state’s increased maternal death rate,” with the main risk coming in women who have multiple c-sections.”
The Atlantic Monthly

Since MotherBaby Network’s 2010 cesarean awareness post, four developments are positively influencing cesarean reduction in Oregon:

  • Oregon Health Sciences University Center for Women’s Health is reducing c-section by changing provider practice. How? Weekly provider reviews to discuss decisions leading to c-section and consistent counseling for women following cesarean surgery about VBAC in the future. Reviewing practices leading to cesarean section encourages a more measured, patient approach that slows the tendency to abandon vaginal birth for non-medical reasons. OHSU Center for Women’s Health director Dr. Aaron Caughey is to be commended for correctly describing the  majority of circumstances resulting in repeat cesarean section as coercive due to the fact women lack access to VBAC.

“The C-section rate in your first pregnancy matters a ton,” Caughey said. “The C-section rate is only about five percent of women with a previous (vaginal) delivery.” – The Lund Report

  • The March of Dimes’s “Eliminating Elective Deliveries Prior to 39 Weeks Gestation: OR Challenge” spurred 17 Portland- metro hospitals to implement policies eliminating non‐medically indicated deliveries before 39 weeks. This policy results in fewer failed inductions, meaning fewer cesarean sections. The Atlantic Monthly covered this important shift in community norms in Why Hospitals in Portland Are Banning Early Births. 34 of 53 Oregon hospitals have since joined the challenge to stop elective deliveries before 39 weeks.
  • The Oregon Public Health Authority collects “mode of delivery” statistics from birth certificates at facility and county levels. Beginning with 2011 data, OPHA now reports VBACs as a mode of delivery. This is key as it provides information about which facilities actually support VBAC and the number occurring on an annual basis. We should see these numbers increasing every year as hospitals and physicians return to patient-centered evidenced-based care.
  • Oregon state health care reform has the potential to transform the current model of care into one in which patient / consumer experience and community health outcomes replace billable procedures as the metric by which hospitals determine best practices.

CostCo is raising cesarean awareness and encouraging prevention in CostCo Connection magazine.

Despite these positive developments, the deck is still stacked for women seeking to maximize individual and infant health and well-being. Gaining insight into the opaque world of provider and hospital philosophies, practices and outcomes is nearly impossible. Even when women ask the right questions, the answers they receive are often unfounded, fuzzy and vague. Consequently, most  remain unaware of the real risks of being subjected to unnecessary primary- and repeat-cesarean section.

Learn more about cesarean section

Learn more about VBAC

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Stepping Toward A Baby-Friendlier Oregon

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The Breastfeeding Coalition of Oregon under the direction of Amelia Psmythe recently hosted its sold-out 5th annual two-day statewide conference – Stepping Toward A Baby-Friendlier Oregon. Supporters who made the conference possible include Oregon WIC, Oregon Public Health Institute, Hygeia, Limerick, and Medical International.

Anyone wanting to know what Oregon’s many infant-feeding stakeholder groups are up to should make a habit of attending. While there is still so much to be done to protect and promote breastfeeding, the following downloadable synopsis of conference presentations will give you a quick bird’s eye view of the excellent and diverse work already underway.

Oregon is fortunate to have an extraordinarily talented cadre of savvy, skilled and committed advocates for quality care. Throughout the state, these advocates promote and protect women’s health, well being and basic human rights spanning the entire arc of their reproductive lives whether at home, in the community, in the health care system, in the economy or as “subjects” of scientific research and inquiry. The BCO annual conference is a good opportunity to check in and rally for the difficult but critical work ahead to achieve breastfeeding’s full-spectrum benefits for the entire population.

Framing the discussion…Presentations and discussion were conceived of and organized to align with the Surgeon General’s Call to Action to Support Breastfeeding (SGCTA). The SGCTA is a federal tool to direct policy, fund activities and align stakeholders around important objectives outlined in Healthy People 2020. Federal, state and local grants and staffing resources are made available and prioritized based on alignment with SGCTA objectives.

The SGCTA to Support Breastfeeding is a ground-breaking document because it is a clear departure  from previous policy and political frameworks that define breastfeeding as an individual responsibility or lifestyle choice beyond the concern, responsibility and reach of government focus. Finally, breastfeeding behaviors and outcomes have been re-defined as the product of cultural norms and structures at all levels of society. Accordingly, public health workers, researchers, employers, health care systems, communities and families are “called to action” to better and more effectively support mothers and babies to breastfeed.

Presentation Synopses. Following is a list of presentations. It gives a wide-angle view of how individuals and institutions are aligning Oregon with the SGCTA. Click here for a version of this post that also includes a synopsis of each presentation.

The Role of Consumer Advocacy in Increasing E-B Infant Feeding Practices
Katharine Gallagher, MPP. Consumer advocate, blogger and independent childbirth educator.
slides
, talk

Let’s Talk! Breastfeeding Education Series Tear Sheet Project
Rachel Martinez, BA, IBCLC, RLC. New Member Training Coordinator at Nursing Mothers Counsel of Oregon, and Legacy Emmanuel Hospital lactation consultant.

The Oregon Black Women’s Birth Survey
Shafia Monroe, Midwife. Founder of the International Center for Traditional Childbearing

Supporting Families the Whole Way: Continuity Care Model
Debbie Alba, RN, IBCLC. Nurse and Lactation Consultant at Good Samaritan Regional Medical Center, currently serving as Western Region Steering Committee Chair

Angie Chisholm, CNM. Certified Nurse Midwife at Samaritan OB/GYN in Corvallis, with a long interest in lactation and evidence-based care.

Oregon WIC Peer Counseling: A Public Health Approach
Kelly Sibley, MPH, RD, IBCLC. Nutrition Consultant and Breastfeeding Coordinator with the Oregon State WIC Program. Coordinates WIC BF peer counselors.

Engaging Community Partners in Breastfeeding Support
Helen Bellanca, MD, MPH. Family physician who has worked with health policy and advocacy for four years, leading insurance collaborative and child care survey.

Lessons Learned on the Way to Baby-Friendly: Providence Newberg
Joanne Ransom, RN, IBCLC. Labor & delivery nurse and lactation consultant at Providence Newberg, former Vice-Chair of Northwest Mothers Milk Bank, new OEBIN co-lead

Redesignation with Baby-Friendly: Strategies for Success
Michelle Stevenson, RN. Perinatal Nurse and former La Leche League Leader, led two CA hospitals to Baby-Friendly designation, and now manages the Women and Newborn Care and Nursery at Kaiser Sunnyside Hospital.

Eliminating Elective Deliveries Prior to 39 Weeks Gestation: OR Challenge
Joanne Rogovoy, Executive Director of the Oregon March of Dimes, and leader of the workgroup that banned early c-sections on Portland area hospitals.

Donor human milk & Northwest Mothers Milk Bank
June Winfield, Board Chair / Director

Breaks for Nursing Mothers are Federally “Reasonable”
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee.

Nursing Mothers Counsel Workplace Lactation Support Program
Marion Rice, Ed.D. 25 year educator, currently leads the Nursing Mothers Counsel of Oregon Worksite Lactation Support Program

What Do Women Really Want? A 21st Century Mother’s Movement
Andrea Paluso, MSW, MPH. Co-founder of Family Forward Oregon, The Mother PAC, and recent graduate of the Emerge Oregon legislative mentoring program.

Breastfeeding Outcomes in Women with a Prior History of Cesarean Section
Cathy Emeis, PhD, CNM. A nurse-midwife and researcher at OHSU, Cathy’s current research examines the impact of birth interventions and c-section on breastfeeding.

Breastfeeding Coalition of Oregon: Northwest Edge of the Wave of Change
Amelia Psmythe, Director of the Breastfeeding Coalition of Oregon and West Region Coalition Representative to the United States Breastfeeding Committee

US Breastfeeding Committee Annual Report
Robin Stanton, MA, RD, LD. USBC Past-Chair and Nutrition Consultant with OR Department of Human Services, Public Health Division

Collaboration for Collective Impact
Amelia Psmythe and Robin Stanton, MA, RD, LD

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Part 2: Consumer Advocacy & Evidence-Based Infant Feeding Practices

Here’s the second “installment” for my upcoming presentation at the March 2-3 Breastfeeding Coalition of Oregon’s 5h Annual Meeting. Blue text indicates information that will be placed on PowerPoint slides, black text indicates what will be said. I’d love your feedback either here or via email at motherbabynetwork@gmail.com. Read the first installment

This installment covers consumer demand, consensus spanning breastfeeding research, accountability organizations and national and state governments, and the new Joint Commission “Speak Up!”campaign.

What does consumer demand by the numbers look like?

Click on chart to enlarge

These statistics, taken from the CDC 2011 Breastfeeding Report beautifully illustrate the strong consumer demand on the part of women to breastfeed. Oregon has exceeded the Healthy People 2020 goal for 81.9% initiation of breastfeeding. What this tells us is that most women today plan to breastfeed – more than 91% initiate breastfeeding. This is great news. But within six months we see a dramatic drop-off, especially when we consider breastfeeding exclusivity. Why is this?

Behind these declining rates are the potholes and gaps of an inadequate infrastructure entirely incapable of meeting and supporting women and families in their infant feeding decision to breastfeed. Soon after or right along with the first latch, mothers and babies face multiple threats to breastfeeding from several angles that hound, hobble and thwart them all along the way. Behind these numbers lurk the stories of women and families who are forced into a choice they initially rejected – formula feeding. Who among us doesn’t know first or second hand the details of these unanticipated transitions to formula and the associated loss of maternal and child health benefits?

What these numbers also fail to illustrate are the social and ethnic inequities perpetuated via barriers to breastfeeding. Unacceptable disparities in breastfeeding persist by race/ethnicity, socioeconomic characteristics, and geography. Here in Oregon, only 25% of African-American mothers and babies are breastfeeding at six months, compared to the 62% of Oregonians. (ICTC Black Birth Survey)

Important as data collection is, standard metrics do not capture the emotions, frustrations and isolation women and families experience when faced with the unanticipated and multiple barriers that threaten and frequently succeed in separating babies and mothers from breastfeeding.

In sum, our maternity care system falls woefully short of meeting consumer demand for effective breastfeeding services. Fortunately, consumers (mothers) are beginning to connect the contradictory advice they receive from physicians, nurses, lactation consultants, nurses’ aids and housekeeping staff with the poor outcomes they experience. More women are beginning to see how gaps in standard hospital practice undermine them before they ever go home to struggle alone. The actions and activities of innumerable local and national groups sprouting up are giving voice to the dissatisfaction women and families feel with the standard of care.

Consumers are not alone in connecting the dots…..

Click on chart to enlarge

In the big picture, women are no longer alone in their search for meaningful support. The time for big change in maternity care is here.

Research

  • Health benefits. We are beyond debating the pros and cons of biologically normative infant feeding. Multiple short- and long-term health benefits of breastfeeding for mothers and babies have been firmly established.
  • Hospital practice. Research conclusively demonstrates that evidence-based hospital practices positively influence breastfeeding duration and exclusivity.
  • Cost savings. Thanks to Bartick et al’s 2009 cost analysis (The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis), we also have clear documentation of the massive projected savings in dollars and lives that come with exclusive breastfeeding.
  • SIDS. 2011 research confirms breastfeeding is associated with reduced rates of SIDS. The effect is stronger when breastfeeding is exclusive. This finding has special significance for my community of Lane County. Between July 2007 and June 2010, 23.5% of 85 fetal-infant mortalities are among post-neonates (babies one month or older). Breastfeeding reduces the risk of SIDS.
  • Childhood obesity. Breastfeeding is associated with reduced odds of obesity throughout the life span with greater benefits conferred with exclusive breastfeeding. Breastfeeding promotion and childhood obesity risk reduction go together.

Accountability

Consumer voices and research findings are increasingly making their way to the top of the agenda for major actors in the development and implementation of health care policies. As these bodies move beyond signaling interest to taking action, forward-thinking hospitals will take action to be in position for a time when reimbursement dollars will be tied to breastfeeding outcomes. Action means adopting evidence-based practice for infant feeding.

  • CDC mPINC. A national survey of hospitals to measure infant feeding policies and practices. Facilities receive private analyses outlining their strengths and areas that need improvement. Unfortunately, consumers are not permitted access to facility-level reports.
  • Joint Commission. The nation’s most important hospital-accrediting body recently included exclusive breast milk feeding in its new perinatal core measure set.
  • US Surgeon General Call to Action and Healthy People 2020. Both documents guide national, state and local health policy making. Increasing the number of breastfed infants is a key public health goal.

Nation

  • Healthcare reform. is a major national issue. Promoting and protecting the rights of nursing mothers to pump included in legislation.
  • Let’s Move. The First Lady’s campaign includes breastfeeding as part of the solution to the childhood obesity epidemic.
  • Transforming Maternity Care. Maternity and infant care are the most expensive hospital condition in the United States – $98 billion in 2008. The US spends more than any other industrialized country on maternity and infant care. The outcomes do not support this spending. Any discussion of improving the healthcare delivery service must focus on maternity and infant care.
  • Breastfeeding. Discussion of infant feeding reform thus fits within a larger context spanning the entire perinatal period from conception through an infant’s first birthday.

Oregon

  • WIC. Oregon WIC is one of only 6 states awarded a Breastfeeding Performance Bonus from USDA, tied for the first time to exclusive breastfeeding rates.
  • Oregon Hospitals Partnering for Evidence-based Infant Nutrition. This is a statewide project of the BCO to provide facility-specific technical assistance and encouragement to hospitals adopting evidence-based practices. The May 2011 hospital summit brought hospitals and community groups together to develop plans for next steps. This summit provided my community’s two leading hospitals (McKenzie Willamette Medical Center and Sacred Heart Medical Center) with an opportunity to publicly share their commitment to become Baby Friendly-designated facilities.
  • Oregon Health Insurers Partnering for Prevention (OHIPP). This group of health insurers selected breastfeeding as an evidence-based prevention strategy for reducing obesity. Incentives to hospitals that attain the Baby-Friendly designation are being explored.

The Joint Commission’s message to mothers? Speak Up!

Now that consumers are joined by research scientists and health policy makers at the national and state levels, we are beginning to see efforts to encourage women to seek and insist on excellent infant feeding care. Having recently signaled to US hospitals that exclusive breast milk for infant nutrition is increasingly on the agenda by putting it as an optional perinatal performance measure, the Joint Commission is signaling again. This time, the Joint Commission is speaking directly to consumers. The Joint Commission’s new “Speak Up!” campaign tells mothers they must take action by “speaking up,” if they are to be successful in realizing their preference to breastfeed.

The medium for this latest signal is a brochure. There are several things to like about this campaign’s brochures:

  • It is intended for distribution during the prenatal period when women have the opportunity to think and plan ahead.
  • Breastfeeding, while a biological norm, is presented as a skill to be learned. Learning requires preparation before, during and after birth for mother and baby
  • Women and support people are encouraged to speak up and ADVOCATE for themselves to ensure they are receiving proper, evidence-based care. In other words, being a squeaky wheel is a good thing.
  • Telling women to speak up implies that they ought not assume their hospital’s care is in line with successful outcomes.
  • The information provided is consistent with Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding and, therefore, is evidence based.

Encouraging personal responsibility is laudable. That said, my reservation with this campaign is that it requires a consumer to have a rather deft capacity to read between the lines. The target audience is unlikely to be able to do this, if they are not first informed that the current and common infant feeding support they are likely to encounter is rife with serious deficits. A more straightforward approach would be great.

I suspect, however, the greatest significance of this campaign is the signal it sends to hospitals rather than to consumers. Brochures are a rather passive form of support that may or not be read by consumers. I am confident, however, that the administrators inside hospitals who make decisions about whether or not to pursue the Baby Friendly designation are able to see this campaign in a larger context – one in which an ever-clearer signal is being sent for hospitals to link doing a better job by consumers with accreditation status. Seen in this light, “Speak Up!” is a very positive development.

— End of installment 2, final installment coming soon. Feedback appreciated!

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Will Oregon hospitals close the breastfeeding care gap?

Evidence-based infant feeding care is the future for hospitals in the United States. Oregon is at a critical juncture: will it lead by building on the unique, forward-thinking approach for which it is known? Or, will it wait for other regions or states to lead? Waiting might make sense for some states but not for Oregon – the home of several cutting-edge leaders, thinkers and organizations where infant feeding is concerned.

Last week, representatives from 35 of Oregon’s 52 maternity hospitals participated in a day-long summit devoted to evidence-based infant nutrition. Provided with resources, expertise and mentoring, hospital teams developed action plans for closing the gap between current infant feeding practices and evidence-based mother-baby care. For background on the infant feeding gap, read “Closing the Quality Gap: Promoting Evidence-Based Breastfeeding Care in the Hospital.”

Prevalent non-evidence-based mother-baby practices include routine supplemental feedings of formula, repeat separation of mother and baby beginning with the first minutes of life and pervasive distribution of formula company marketing samples to breastfeeding mothers. Optimal care following birth includes skin-to-skin time, keeping mother and baby together and care from trained and educated staff. Optimal care occurs in a commercial-free environment.

The summit marked the half-way point in the year-long Oregon Hospitals Partnering for Evidence-based Infant Nutrition – a project of the Breastfeeding Coalition of Oregon, one of five community coalitions supported by the Oregon Public Health Institute. (See The Lund Report’s coverage) Amelia Psmythe, director of the Breastfeeding Coalition of Oregon, provided much of the vision, creative energy and sheer determination necessary to make this potentially-transformative opportunity available to Oregon hospitals. Because of her uniquely collaborative approach to the summit, teams returned to their respective hospitals prepared to begin the work of aligning infant feeding care with the high expectations mothers, families, communities, employers and governments at all levels have for them.

With the Breastfeeding Coalition of Oregon as its principal organizer, the project develops collaborative relationships inside and outside hospitals and provides technical support to assist reform efforts. Funders include:

  • Oregon Public Health Institute
  • Multnomah County Health Department
  • Oregon WIC
  • Oregon Association of Hospitals and Health Systems
  • Legacy Health System
  • Kaiser Permanente
  • Providence Health & Services
  • Oregon Health & Science University
  • Tuality Healthcare
  • Medela, Inc.

Funders as well as community partners attended the summit. Community partners included MotherBaby Network, Northwest Mother’s Milk Bank, the Nursing Mothers Counsel of Oregon, Multnomah County Health Department, Multnomah WIC, the March of Dimes, the Oregon Health Authority and the United States Breastfeeding Committee.

US Sen. Jeff Merkley’s wife Mary Sorteberg, RN presented awards to the state’s five Baby Friendly facilities and to four with formal commitments to become designated. Visit the Breastfeeding Coalition of Oregon’s Facebook page to see photos. The Baby Friendly Hospital Initiative (BFHI) – a global program sponsored by WHO and UNICEF to promote, protect and support breastfeeding – certifies hospitals practicing the Ten Steps for Successful Breastfeeding. Women receiving lactation services at a Baby Friendly facility can be confident of comprehensive evidence-based care.

The Centers for Disease Control is monitoring the project’s trajectory. Its early success engaging and leveraging the interests and resources of multiple constituencies inside and outside of Oregon hospitals warrants this attention. Depending on how the next several months unfold, an effective model for other states could result. Such a model would have national significance in light of the current CDC focus on encouraging exclusive breastfeeding for the first six months of life as the public health intervention with the greatest potential for addressing the skyrocketing rates of childhood obesity.

Lane County

Lane County had a strong showing at the summit. The county is home to the state’s first facilities to earn Baby Friendly status: the PeaceHealth Nurse Midwifery Birth Center and the Cottage Grove Healthcare Community (since closed), both in 1997. The county’s two largest hospitals, Sacred Heart Medical Center and McKenzie Willamette Medical Center, both sent teams. All four facilities were acknowledged during the morning award’s ceremony. Lane County could be on the path toward evidence-based infant feeding as a community standard.

Lane County’s Desiree Nelson works on behalf of the project. Nelson led Cottage Grove’s hospital to become a designated facility in 1997 and, until recently, worked at the PeaceHealth Nurse Midwifery Birth Center. She is also co-founder, along with Debbie Jenson of Sacred Heart, of Baby Connection, a phenomenally successful grassroots demonstration project of evidence-based, drop-in breastfeeding support groups. The existence of post-discharge groups satisfies Baby Friendly step 10. Baby Connection serves all women and families.

What did hospital teams do?

Throughout the day, hospital teams developed facility-specific action plans. Team members included physicians, labor and delivery managers, family birth center managers, charge nurses, lactation consultants, childbirth educators and quality improvement staff. 

As a condition of participation, hospital teams arrived having reviewed the latest CDC 2009 benchmark data for their facility. This data is captured in the CDC Maternity Practices in Infant Nutrition and Care (mPINC) reports. Teams updated their benchmarks to reflect 2011. These advance team-based activities were intended to ensure familiarity with current practices and policies.

Aggregate state-level mPINC data will soon be available. Facility-specific results are currently anonymous. Anonymity is considered key to participation. Download a Sample Benchmark Report. mPINC reports for other states’ facilities are being printed now. The CDC expedited shipping to support the work of the summit.

At the summit, participants were guided by Carol Melcher, RNC, CLE, MPH – clinical director of San Bernardino’s Perinatal Services Network (PSN). Melcher has led numerous hospitals in San Bernardino county to achieve Baby Friendly designation. PSN instructs hospitals in the SOFT Approach which teaches hospitals to earn designation by building connections that align cultural and procedural priorities with evidence-based care. Needed connections include those between families and staff, between administrators and nurses, between hospitals and between communities and hospitals. These connections place collaboration ahead of competition.

A critical resource for results-oriented learning and facility-level planning was the multiple interactions teams had with small table mentors. Mentors brought expertise in one of three areas: hospital Quality Improvement,  leading a hospital to the Baby-Friendly designation, and large-scale systems change. Hospital teams worked with one of each type of mentor. Mentors volunteered their time at the summit as well as during an advance training session.

To provide an observation-free environment for hospital teams, community partners convened separately following the awards ceremony. They received a briefing on hospital team activities and a presentation by Northwest Mothers Milk Bank.

Why are hospitals ground zero for closing the infant feeding gap?

Hospital-based culture and practices create an environment in which individuals make long-lasting decisions about infant feeding. These first decisions and experiences heavily influence the ultimate role breastfeeding will play in the months to come. Hospital reform is critical for realigning prenatal, birth and postpartum environments to support —rather than thwart— individual feeding decisions that lead to the multiple positive outcomes associated with breastfeeding. Read this consumer survey to learn what women and families have to say about care in a Baby Friendly facility that aligns with their decision to breastfeed.

A well-known recent study reports that 911 deaths, mostly among infants, could be averted and $13 billion per year saved, if 90% of US families breastfeed exclusively for six months. Despite considerable room for improvement, Oregon leads the nation in breastfeeding benchmarks. It starts off with an “A” but quickly plummets to a failing grade by month six. Nine in 10 Oregonian women initiate breastfeeding. At six months, 2 in 10 babies are exclusively breastfed. Even with a failing grade, Oregon is frequently touted as an example for other states.

Like the CDC, the Oregon Health Insurers Partnering for Prevention (OHIPP), another OPHI project, is also monitoring the project. Comprised of health insurers (representing 65% of private insurance and 45% of Medicaid) and public health policy advocates, OHIPP is a collaborative obesity prevention effort. It has selected increasing breastfeeding rates as its first collaborative public health intervention. Imagine the potential for moving Oregon forward were insurers to set a date for implementing different rates of reimbursement depending on a hospital’s Baby Friendly status?

Sorteberg described Sen. Merkley’s state and national legislative efforts to protect and promote the rights of breastfeeding women in the workplace. Her comments highlighted the need to work across barriers so that women will have hospital care that lays the foundation for returning to work with plans to continue breastfeeding intact. Without effective hospital-based support systems, the potential for current legislation is severely undermined.

Effective community connections reach beyond hospitals

Developing opportunities for hospital teams to identify and work with their local community partners is critical to the project’s long-term prospects. The Surgeon General’s 2011 Call to Action to Support Breastfeeding encourages the involvement of multiple groups for the removal of barriers. Families, communities and employers also have an active role in removing barriers. Including these stakeholders in the work of hospital-practice reform is key ingredient for making long-lasting, sustainable change.

Oregon’s strong showing of community partners at the summit points to an inherent and potentially unexamined strength for creating not only a state network of Baby Friendly hospitals but a model of care consistent with current calls to develop patient / consumer engagement in healthcare-decision making models. The SOFT Approach begs to be made Oregonian by actively including the perspectives of local community stakeholders in hospital teams.

What might this look like? Hospital teams can add a healthcare consumer of breastfeeding services to their efforts. Breastfeeding coalitions, La Leche groups, WIC peer counselors and healthy baby coalitions are potential sources for participants with relevant consumer perspectives. As the project moves beyond the summit to develop state-level collaborative frameworks, meaningful inclusion of local community partners should be a priority, too.

Women frequently take the lead in decision making for nuclear and extended family members. The manner and degree in which they participate in healthcare decisions during pregnancy and postpartum have major implications beyond infant feeding. Consumer (or patient) engagement promotes effective partnering for prevention and treatment practices throughout the life cycle. Including consumer perspectives in the discussions and planning that must occur to close the infant feeding gap has the potential to set the even further-reaching example of the kind of collaboration needed to make quality healthcare more affordable and accessible across the life cycle.

Beyond the summit

Urban or rural, rich or poor, large or small, degree and type of diversity among populations served  – these are not the characteristics that determine a hospital’s capacity to become Baby Friendly. Commitment to building the necessary connections for closing the current gap is the single-most important distinguishing characteristic for change. Developing and utilizing internal and external lines of communication within and among hospitals as well as with community stakeholders and setting milestone dates are far more important than specific facility characteristics. Facilities making the needed commitments and seeking opportunities to collaborate are in a position to close the infant feeding gap. Those who succeed will align with their mission by honoring their obligation to the mothers and babies of Oregon. It is possible that Oregon could make evidence-based infant feeding care a statewide community standard.

 

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OR state leg update – 2 bills of special interest to moms and babies

Following is an update on proposed 2011 Oregon state legislation with the potential to influence perinatal outcomes.

Oregon House Bill 2380

Recently amended, HB 2380 creates a majority of licensed direct-entry midwives on the Oregon Board of Direct Entry Midwives. This is accomplished by reducing the total number of board members from eight to seven. The bill also establishes protected peer review for licensed direct entry midwives. Additionally, the bill requires the Board to collect and report birth data. Outcomes between licensed and unlicensed direct entry midwives will be distinguished in Board reporting.

Before amendment, HB 2380 would have required Oregon’s direct-entry midwives to become state licensed providers. This would have replaced the current voluntary licensure system. MotherBaby Network blogged about this proposed requirement shortly after the bill was  introduced in February. The Lund Report just reported on amending of this bill.

The Oregon Midwifery Council supports HB 2380 and encourages its supporters to contact their state representative in the House to encourage a “yes” vote.

Oregon House Bill 3311

HB 3311 has been amended to require that the “Oregon Health Authority, including the Office of Multicultural Health and Services, shall explore options for providing or utilizing doulas and other community health workers in the state medical assistance program to improve birth outcomes for women who face a disproportionately greater risk of poor birth outcomes.” If passed, OHA would report outcomes to the Health Care Committee in February 2012.

The original bill language focused on improving outcomes for women of color. The amended language is improved by expanding 3311’s focus to include all women who are at a disproportionate risk for poor outcomes. This bill is of particular interest for Lane County, where MotherBaby Network originates, given its disturbingly high rate of fetal-infant mortality. Our overall rate is higher than the nation; higher than the state; and higher than comparable counties and metropolitan areas.

HB 3311 has the potential to address gaps in maternity services by better-integrating doulas and community health workers into the model of care. Doulas are labor companions who provide the emotional and non-medical support all to frequently absent from a laboring woman’s side. Doulas are a well documented evidence based and non-medical intervention with a proven track record for positively influencing the social, physical and emotional outcomes of the perinatal period.

HB 3311 follows Amnesty International’s 2010 release of Deadly Delivery: The Maternal Health Care Crisis in the USA.  Amnesty International reports that despite spending more than any other country on earth on maternal health, US women are at greater risk of dying of pregnancy-related complications than their counterparts in 49 other countries including Kuwait and Bulgaria. Among US women, African-American women are nearly four times as likely to die of pregnancy complications than white American women.

HB 3311 enjoys support from bill sponsor Rep. Tina Kotek as well as from the following organizations:

Coalition of Local Health Officials

International Center for Traditional Childbearing

The Urban League of Portland

Decisions About Infant Feeding Do Not Happen in a Vacuum – Context Matters

In celebration of its 50th anniversary, Oregon Research Institute recently hosted a public lecture – “Addressing the Nation’s Crisis with Nutrition and Obesity” – by Kelly Brownell, director of Yale’s Rudd Center for Food Policy and Obesity. In the past several years, obesity prevention has gained enough traction to be a well-established national health priority. Public and private funders are actively looking for solutions to cut down on the enormous and growing costs of addressing the innumerable diseases and suffering associated with and exacerbated by obesity.

Curious to see if breastfeeding would figure into the lecture, I attended…

What’s the connection between obesity reduction and breastfeeding? Breastfed children experience lower rates of obesity than do formula-fed babies. Why? “Scientists do not know exactly why… Some people think that a breastfed child can better control how much he or she eats and so may become accustomed to eating less than a bottle-fed child… Also, babies who are breastfed have lower levels of insulin, a hormone that promotes fat storage.”

Because breastfeeding is associated with better outcomes, it, too, is enjoying newfound traction in policymaking circles. Oregon’s one-a-kind insurance collaborative – Oregon Health Insurers Partnering for Prevention (OHIPP) – selected breastfeeding as its first intervention intended to reduce obesity. Nationally, Michelle Obama promotes breastfeeding as part her campaign to reduce childhood obesity.

A well-known recent study reports that 911 deaths, mostly among infants, could be averted and $13 billion per year saved, if 90% of US family could follow medical recommendations to breastfeed exclusively for six months. Nine in 10 Oregonian women initiate breastfeeding. This number declines rapidly so that at six months, 2 in 10 babies are exclusively breastfed.

After establishing obesity as a global epidemic of the first order, Kelly focused his lecture on reduction and prevention in the United States through meaningfully addressing the manufacture and sale of the foods and beverages fueling today’s ghastly health outcomes. Breastfeeding was not discussed. However, the ideas and suggested pathways to obesity reduction that Kelly sketched out are well suited to the development of strategies for reforming the inadequate breastfeeding support models currently accessible to most women and babies here in Lane County and elsewhere.

…reform comes when the environment in which individual choices are made is geared to support rather than thwart decisions that align with healthy, positive outcomes…

Reform: Clean Up for Infant Feeding Models

Brownell argues that real reform comes when the environment in which individual choices are made is geared to support rather than thwart decisions that align with healthy, positive outcomes. Currently, models to promote well-being, whether for nutrition or infant feeding, exist within an environment that encourages behaviors associated with poor outcomes. Today’s decision-making environment for infant feeding is shaped by legislation, regulation and economic prerogatives that promote and protect the interests of manufacturers and non-evidence-based practices at the expense of individual, family and community wellbeing. The current “default settings,” as Kelly refers to them, run counter to science, transparency and good health practices.

In this kind of “toxic” decision-making environment, Brownell describes the disproportionate responsibility individuals bear in becoming educated and motivated to identify evidence-based or effective care and accessing it.  Current default settings put consumers at so great and extreme a disadvantage in making informed decisions that it is unreasonable to expect improved outcomes to result from individual responsibility alone. In other words, individuals are “thrown to the wolves” and then summarily blamed for making the wrong decision – all in the name of personal responsibility.

What is needed to address an asymmetrical and toxic decision-making environment? The default settings must be reset to optimize individual decision making and public well-being. Legislation, regulation and economic practice must be redirected to protect and reward practices that promote rather than undermine individual and national health and economic well-being.

Anyone following funding for Women, Infants and Children can see the power of formula company interest groups on full display. Through costly and effective lobbying campaigns, these companies succeed in shaping national policy for their own benefit and at an extraordinarily high cost to everyone else. These companies create the toxic environment in which WIC is cornered into purchasing and providing formula rather than evidence-based infant feeding support systems. To think the nation’s most vulnerable women and children bear responsibility for allowing this to happen is ludicrous.

Shifting a decision-making environment to empower choices in line with good health and economic outcomes is not a new idea. Before obesity reduction and breastfeeding promotion managed to make it onto the national agenda, other examples abound in which default settings have been positively reset. Smoking cessation and tobacco regulation is just one, good and well-known example. Another example? Air bags. All new cars now come equipped with them but this wasn’t always so. Having one or not is not a private but a public decision. This idea is so firmly supported by legislation and regulation that buying a new car without one is impossible.

Improvement looks like…

What if default settings for infant feeding were optimized to serve the nutritional and economic interests of women, babies, families and communities? Here are few ideas for what a non-toxic environment would look like….

  • Evidence-based breastfeeding models of care in hospitals and birth centers
  • Higher reimbursement rates for evidence-based facilities and providers
  • Universal access to early and comprehensive prenatal care
  • Access to evidence-based childbirth and breastfeeding education as part of prenatal care
  • Effective employer-based supports systems to support breastfeeding mothers

In Lane County, there are positive signs of increased access to evidence-based breastfeeding models. Sacred Heart Medical Center is pursuing the Baby Friendly Hospital Initiative designation for evidence-based care. McKenzie Willamette Medical Center reports being in the midst of internal discussions about a similar commitment to mothers and babies in our community. The PeaceHealth Nurse Midwifery Birth Center is already one of Oregon’s five designated facilities. See what women who access breastfeeding care have to say about Baby Friendly care – read A Consumer Survey on Baby Friendly Breastfeeding Services.

Sacred Heart to become Baby Friendly, McKenzie-Willamette exploring designation

Since posting Project Aims to Improve OR Hospital-Based Breastfeeding Services, MotherBaby Network has received a good deal of positive feedback from individuals in healthcare, elected office, local government, the insurance industry, the non-profit sector as well as from consumers. The post describes a new statewide project (Oregon Hospitals Partnering for Evidence-Based Infant Nutrition) that support hospitals in developing the evidence-based infant feeding practices associated with increased rates of breastfeeding and better health outcomes.

MotherBaby Network received the following information from Sacred Heart Medical Center and McKenzie-Willamette Medical Center regarding plans for the Baby Friendly designation at each facility. Pursuit of this designation provides facilities with a clear pathway for developing the knowledge and effective practices to properly support breastfeeding. It is a clear signal to women and families that they can have confidence in a facility’s infant feeding services.

Sacred Heart Medical Center Intends to Become a Baby Friendly Facility

Sacred Heart Medical Center will pursue the Baby Friendly Hospital Initiative’s designation. An interdisciplinary group of L&D nurses, physicians of several specialties and administrators has been formed. A letter of intent to Baby Friendly will go out before July 1, 2011.

McKenzie-Willamette Medical Center Exploring Baby Friendly

McKenzie-Willamette Medical Center is exploring pursuit of the Baby Friendly status.

If both SHMC and MWMC were to become Baby Friendly, evidence-based infant-feeding would become a community standard. Hopefully, both hospitals will join the new collaborative, statewide hospital effort to support these efforts. Interested parties should contact Amelia Psmyth at Amelia@breastfeedingOR.org or Desiree Nelson at Desiree@breastfeedingOR.org.

These latest state and local developments around breastfeeding reform occur in a national context of growing awareness and support for improving the circumstances in which women, families and communities welcome babies. Issuing the first-ever Call to Action for breastfeeding reform, Surgeon General Regina M. Benjamin is the latest national figure to add her support. Describing the multiple, overlapping barriers in communities, healthcare systems and places of employment, Benjamin urges the nation to remove them so that women will no longer be forced to stop breastfeeding sooner than they want or discouraged from initiating breastfeeding. More information: www.surgeongeneral.gov.

Interested in what local women and families who have used evidence-based breastfeeding services have to say? Read Lane County Friends of the Birth Center’s consumer survey.

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Lane Co’s extends prenatal to women ineligible for OHP due to immigration status

Following six other counties, Lane County is implementing Oregon’s Prenatal Expansion Program to provide Oregon Health Plan (OHP) Plus Prenatal services to pregnant women who have “Citizen / Alien Waived Emergency Medical” (CAWEM) coverage.

Expansion of CAWEM coverage to include prenatal care is made possible through the federal Children’s Health Insurance Program (CHIP) that allows States to serve the unborn children of women who would be Medicaid-eligible except for immigration status. Oregonians access Medicaid through OHP.

The CAWEM Plus prenatal benefits are the same as OHP Plus with four exceptions: sterilizations, therapeutic abortions, hospice care services and death with dignity services. Maternity coverage ends at delivery, unless postpartum services are provided through a bundled (packaged) rate. The newborn will be enrolled in OHP Plus for one year of automatic eligibility.

Providers accepting OHP can now serve CAWEM Plus clients. For more information, see the Provider Alert Sheet (includes Spanish-language description) and Quick Facts. Clients can enroll at any Department of Human Services site.

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Project Aims to Improve OR Hospital-Based Breastfeeding Services

With funding support from Oregon WIC and Multnomah County Health Department, the Breastfeeding Coalition of Oregon (BCO) recently launched a new statewide project – Oregon Hospitals Partnering for Evidence-Based Infant Nutrition. This project supports hospitals in developing the evidence-based systems associated with increased rates of breastfeeding.  The project aims to promote evidence-based hospital maternity practices related to breastfeeding by offering technical assistance, convening a spring 2011 hospital summit, and supporting the formation of a hospital collaborative learning community.

Lane County’s Desiree Nelson joins the project’s four-member team:  BCO Director Amelia Psmythe, Helen Bellanca, MD, MPH, Rachel Burdon, RN, MPH, and Mary Lou Hennrich, RN and Executive Director of Oregon Public Health Institute (OPHI).  Oregon WIC allocated federal funds for increasing breastfeeding rates through outreach to hospitals. Locally, Nelson is well known for co-founding Baby Connection, a phenomenally successful live demonstration of Baby Friendly step 10:

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Arriving early and leaving well after closing time, families and babies consistently demonstrate the very real but unmet demand for weekly, drop-in evidence-based lactation support in the weeks and months following birth.

Key Backers

The BCO’s parent organization, the Oregon Public Health Institute recently formed an innovative working group for health insurers – the Oregon Health Insurers Partnering for Prevention (OHIPP). The first of its kind in the nation, OHIPP is a collaborative obesity prevention effort between health plans and public health policy advocates.

Currently, six health insurers participate in OHIPP – representing 65% of private insurance and 45% of Medicaid. Insurers contribute money to fund selected interventions. Because breastfeeding is increasingly associated with reduced risk of childhood obesity, OHIPP has selected increasing breastfeeding rates as its first collaborative public health intervention.

OHIPP’s direction could have a huge impact on breastfeeding practices in Oregon. Imagine, for example, the impact of a reimbursement system in which rates for births were higher for hospitals certified as evidence based by the Baby Friendly Hospital Initiative. This type of innovative intervention conveys the importance of becoming evidence based and signals growing understanding that evidence-based care is preventive and effective in the long run.  In this scenario, hospitals would be incentivized to seek support and resources like those the BCO is offering through this project.

Additional critical support for evidence-based breastfeeding services comes from the Oregon Association of Hospitals and Health Systems (OAHHS). A recent OAHHS membership survey indicates 85% of nurse managers are aware of the gold standard for evidence-based breastfeeding support systems – the Baby Friendly Hospital Initiative. 39% want technical assistance and support on Baby-Friendly 10 Steps. Plans are underway for OAHHS to partner with the BCO to co-brand educational opportunities and communicate the importance of evidence-based breastfeeding support to its membership.

Hospital Outreach

The Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project is in the initial outreach phase to hospitals and health system leaders. Interested hospitals are encouraged to begin forming multi-disciplinary teams for the purpose of assessing current internal practice. Representatives from these teams will be invited to participate in a Spring 2011 summit for a day of education, group facilitation and collaboration. Participants will be encouraged to form an ongoing network of communication between their facilities, to support the path toward institutional change.  Interested hospitals should contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

Lane County’s PeaceHealth Nurse Midwifery Birth Center is one of four Baby Friendly Hosptial Initiative-designated facilities in Oregon. Community and consumer support for moving the birth center from downtown Eugene to the new Sacred Heart Medical Center campus in Springfield were centrally linked to the unwavering demand for ongoing access to evidence-based breastfeeding services. Judging by the outcomes and immense demand for these services, making them available at the county’s two leading hospitals, Sacred Heart Medical Center (SHMC) and McKenzie-Willamette Medical Center would be a tremendous boon for families and communities.

Next week, Lane County Friends of the Birth Center will release results from a recent survey taken by more than 100 local women and families describing their experiences evidence-based breastfeeding services at the PeaceHealth Nurse Midwifery Birth Center. Demonstrating the connection between evidence-based services and consumer satisfaction, LaneCoFBC intends the survey to encourage all Lane County hospitals to achieve the Baby Friendly designation. For a copy of the survey, email lanecofbc@gmail.com. (Click here to access the survey.)

Progress already

Locally, there is positive discussion of SHMC RiverBend Labor and Delivery staff’s recent innovative and successful introduction of uninterrupted skin-to-skin contact immediately following birth. Providing skin-to-skin as standard care is a very positive development because it is bedrock practice for developing evidence-based breastfeeding services. Babies placed skin-to-skin with their mother are more likely to be breastfed and to breastfeed for longer.

Having SHMC Labor and Delivery staff describe how front-line practices and internal systems have been altered to bring more evidence-based care to the floor is an example of useful information that could be shared at the upcoming Spring 2011 summit hosted by the Oregon Hospitals Partnering for Evidence-Based Infant Nutrition project. Attending health professionals would return to their respective hospitals with a concrete, doable action for improving mother-baby breastfeeding outcomes.

Writing on the wall

Discussion of evidence-based breastfeeding care is a roundabout way of saying hospitals should identify ways to understand and implement Baby-Friendly practices. Savvy hospitals understand consumers, legislators, government agencies, the business community and accreditation bodies have connected hospital-based breastfeeding practices with the success mothers and babies have in the months following discharge.

Perusal of the following links demonstrates a trend toward adoption of Baby Friendly language for discussions of evidence-based care. They also demonstrate large-scale convergence around breastfeeding as a top-ranking major objective in health care.

  • The Joint Commission’s new perinatal care core measure set includes exclusive breast milk feeding

The question hospitals must answer about breastfeeding services is no long whether or not to become evidence based but (1) how to do it and (2) how to demonstrate that it is being done. Because Baby-Friendly is the established and universal standard for effective breastfeeding care, pursuing and maintaining this designation answers both questions in the most expedient manner. The project’s greatest potential value to hospitals lies in the efficiencies it can generate through developing models of collaboration for identifying and removing barriers to reform. The potential for idea sharing and cost sharing for staff training and education increases significantly with each hospital’s commitment to participate.

To learn more, contact Amelia@breastfeedingOR.org or Desiree@breastfeedingOR.org for more information.

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Maternity Act – doing right by pregnant women and babies, everyone benefits

Despite mounting evidence to the contrary, bipartisan efforts aren’t dead in Washington, D.C. Just before Thanksgiving, Congressman Elliot Engel (D-NY) and Congresswoman Sue Myrick (R-NC) filed the Partnering to Improve Maternity Care Quality Act of 2010 (MCQA). This act begins the necessary work to remove the multiple, interlocking barriers separating women and babies from effective care.

MCQA is a prudent and overdue response to several years’ worth of reports and media coverage of the appalling disparities in access and outcomes for mothers and babies across and within communities in this country. Amnesty International’s Deadly Delivery: The Maternal Health Care Crisis in the USA is the latest report. Inside these reports are the details of our embarrassingly high national maternal mortality and infant maternal mortality rates. The most tragic of outcomes, these mortalities are a “canary in the mind shaft.”

62 Lane County babies lost before first birthday

Lagging behind 40 to 50 nations, including all other industrialized nations, the country’s infant mortality rates are evidence of far too many tragic and suboptimal outcomes for a country of our resources and standing. This is especially true given that US per-capita spending far exceeds that of any other country on the planet. Locally, Lane County’s fetal-infant mortality rate leads the state – 62 babies were lost before their first birthday from July 1, 2007 to June 30, 2009.

We’re talking serious money and not enough to show for it

The federal government has a big interest in seeing better outcomes for mothers and babies. Annually, 4.2 million babies are born in the US. Medicaid pays for more than 40% of all maternal hospital stays. Put another way, over half of hospital discharge bills going to Medicaid are for childbearing women and newborns. This adds up to a $39 billion dollar business. It’s reasonable to expect a better than below 40 ranking for this kind of investment.

MCQA does three things:

1. Develop a maternity care quality measurement program

Specifically, a complete set of national, evidence-based, quality consensus measures to assess processes, outcomes, and the value of maternity care provided to Medicaid and CHIP (Child Health Plus) beneficiaries will be developed.

2. Identify payment mechanism improvements

A national demonstration project to identify and evaluate emerging payment reform mechanisms that actually support high-quality, high-value care will be created. An example would be bundled payment for a complete care provided to women and newborns.

3. Identify essential evidence-based maternity care services

The Institute of Medicine will be authorized to identify a package of essential evidence-based maternity care services for childbearing women and newborns.

Creating and bringing each of these components to bear on our under-performing maternity care system would go a long way toward providing early prenatal care, effective breastfeeding support, stemming the tide of induction-driven preterm births and the cesarean epidemic and so much more.

More than a chit for motherbaby advocates

MCQA is much more than a boon or chit for motherbaby advocates. Rather, it fits part and parcel with all other efforts to move national and local economies beyond recession. Healthier women and babies mean stronger families, workforces and communities. Women now make up a majority of the paid workforce. Never have employers and government had a more obvious reason to support maternity care reform.

Don’t you think DeFazio should co-sponsor?

Let’s encourage Congressman DeFazio to co-sponsor MCQA. Send him a message using his email form. Be sure to refer to MCQA by its bill number: H.R. 6437. Feel free to copy and paste a link to this blog in your message.

Some media coverage please…..

As a final thought and in addition to legislative action, serious and ongoing local Lane County coverage of these bedrock issues affecting the well being of women and babies would be helpful. Despite high fetal-infant mortality rates in Lane County, community-level coverage has been scant at best.

The Sacramento Bee’s recent coverage of its local fetal-infant mortality rate is a positive and productive example of the kind of coverage needed in Lane County. The Bee article gets beyond the numbers to put a human face on the complicated but addressable issues contributing to the unnecessary suffering and loss of life.  Here’s hoping we see better (any?) coverage from, among others, The Register Guard, The Eugene Weekly and KLCC in 2011.