e-CIMS News: Coalition for Improving Maternity Services Newsletter

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CIMS participates in key policy recommendations to improve health care

CIMS was among the 165 co-signers of the important recommendations of Stand for Quality's report, "Building a Foundation for High Quality, Affordable Health Care: Linking Performance Measurement to Health Reform," (PDF) which was delivered to Congress and the Obama Administration on March 24, 2009. Stand for Quality is a collaborative project of a coalition of consumer groups, health professionals, health plans, hospitals, and employers that developed six recommendations to improve access, quality, and affordability of healthcare in the United States. Included in the recommendations is the support for informed decision making and patient-centered health care. As a coalition of health professionals, consumer advocates, and grassroots organizations, CIMS took this opportunity to voice its concerns about the importance of transparency and consumer involvement in all aspects of health care reform. Stand for Quality is one of several collaboratives that CIMS has joined as part of our mission to promote Mother-Friendly Care.

CIMS joins national health care leaders in calls for improved maternity care policy

On April 3, 2009, CIMS joined over 230 health care leaders in Washington, DC, for Childbirth Connection's national invitational policy symposium, Transforming Maternity Care: A High Value Proposition. The symposium brought together stakeholder workgroups of quality and measurement experts, consumers and their advocates, maternity care clinicians and educators, hospitals, health systems and other delivery care models, and health plans, purchasers, and liability insurers. CIMS leadership and other symposium participants reviewed and offered feedback on workgroup recommendations answering the question "Who needs to do what, to, for, and with whom to improve the quality of care in the next five years?" Symposium proceedings and the compiled Blueprint for Action will be published in a special issue of the journal Women's Health Issues in late 2009.

ACNM issues Seven Key Principles to Health Care Reform

The American College of Nurse-Midwives (ACNM) recently outlined Seven Key Principles of Health Care Reform (PDF) as part of its legislative campaign to improve the quality of women's health care and access to midwifery services. The principles reaffirm ACNM's commitment to universal and improved access to high quality care, reducing health disparities, focusing health care resources on wellness, disease prevention and primary care, and aligning payment systems with evidence-based practice and optimal outcomes. CIMS supports ACNM and others who are working to promote wellness models of evidence-based maternity care in the ongoing healthcare reform discussions.

Informed Consent and Refusal in Maternity Care

Perinatal mortality and morbidity rates, obstetrical interventions, and health disparities between different groups of mothers are on the rise. The benefits of informed decision making may help close the gaps and contribute to improved outcomes for mothers and infants across the board. New research published in the Journal of Perinatal Education highlights the urgent need to address the gap between legal mandates for informed consent and refusal, and maternity care as it is currently practiced in the United States. "Women of childbearing age are a special sub-group of health consumers: they want more information about options than any other group, and when they participate in making healthcare decisions, mothers feel an increased sense of responsibility for their own health as well as the health of their baby," stated Holly Goldberg, author of the study. Co-author Tabare Depaep explained, "Mothers who are involved in making decisions during labor have less fear, suffer fewer depressive episodes, show less symptoms of post-traumatic stress, and have shorter recovery periods."

The CIMS Evidence and Action Committee (EAC) is currently developing patient education brochures and will host a Webinar on this topic on June 19 (registration coming soon). To volunteer with the EAC, contact CIMS.

CIMS collaborates with the March of Dimes to develop new fact sheets

Dr. Charles Mahan, founding chair of the Florida March of Dimes Prematurity Work Group, and members of the CIMS Evidence and Action Committee (EAC) are collaborating on the development of four key fact sheets: cesarean section, epidural anesthesia for labor, elective induction of labor, and VBAC. The fact sheets will include topic-specific informed consent/refusal questions to help women make fully informed decisions that meet their needs. "The majority of childbearing women in the United States are not aware of the risks and ultimate consequences of current birth practices and interventions on their health or the health of their babies," stated Barbara Hotelling, MSN, WHNP-BC, LCCE, CD(DONA), chair of the EAC. "Consumer education pamphlets are often not fully transparent and omit or reduce the full negative outcomes of these practices, which can significantly influence a woman's choice to accept or refuse them." CIMS and the March of Dimes want both childbearing women and health professionals to be aware of the health impact of these care practices and are working to facilitate change towards more Mother-Friendly Care.

Dr. Charles Mahan and the Florida Chapter March of Dimes Prematurity Workgroup

New consumer resource for information on home birth and midwifery care

Mothers Naturally is a web-based public education program from the Midwives Alliance of North America (MANA). It was developed to increase awareness about safe natural birth options and the midwifery model of care. This site provides expectant parents with questions and answers to guide them through discussions about home birth, non medicated labor, and the empowering experience of a woman-centered, supportive birth. Mothers Naturally also helps parents locate midwives in their communities. Through the Foundation for the Advancement of Midwifery, MANA grants funds to non-profit organizations for programs and projects that educate the general public and/or policy makers about the midwifery model of care, increase access to midwifery care, or support research activities relating to midwifery care.

Breastfeeding Is Priceless - a new fact sheet from CIMS

CIMS has recently published an updated evidence-based fact sheet, Breastfeeding Is Priceless: There is no Substitute for Human Milk (PDF). In addition to including the latest research on the health benefits of breastfeeding for both mother and baby, this fact sheet for the first time has collated the research evidence linking the impact of routine birth interventions, invasive procedures, and medications on breastfeeding. "Maternity care providers may not be aware that common birth practices can complicate labor and birth and interfere with the initiation and success of breastfeeding," stated Nicette Jukelevics, MA, ICCE, author of Understanding the Dangers of Cesarean Birth: Making Informed Decisions, and co-author of the fact sheet.

Another important addition to the fact sheet is the inclusion of CDC recommended guidelines for birth facilities to increase the number of mothers who initiate and continue to breastfeed. "The CDC recent national survey of hospitals found that care providers are not doing an adequate job of helping mothers with breastfeeding, especially in not keeping healthy mothers and babies together and skin to skin in the all important minutes and hours after birth when the baby is likely to be alert and ready to breastfeed," said Ruth Wilf, CNM, PhD, CIMS' representative to the United States Breastfeeding Committee, and co-author of the fact sheet with Jukelevics. "We hope that this evidence will increase awareness of this issue and encourage providers to establish evidence-based practices to support mothers and families with breastfeeding. "

CDC's Laurence Grummer-Strawn 2009 CIMS Forum

The CDC's Laurence Grummer-Strawn, MPA, MA, PhD, at the 2009 CIMS Forum presented "The State of Maternity Practices in the U.S.: Are Hospitals Supporting Breastfeeding?" This presentation and others are available for download from the CIMS Web site.

Research Update from The Baby-Friendly Initiative

An early first breastfeed is recommended for infants of diabetic mothers
New research underscores the importance of an early first breastfeed for babies of diabetic mothers. Babies of diabetic mothers are at increased risk of hypoglycaemia and, as such, an early feed is recommended. The study, published in the Journal of Human Nutrition and Dietetics, was carried out to ascertain both the impact of an early feed and to establish what type of feeding provided the best option to reduce the risk of hypoglycaemia.
Breastfeeding malnutrition; reducing incidence by audit and change in practice
Hypernatraemic dehydration (HD) is a potentially serious complication in breastfed babies. New research published in the journal Archives of Disease in Childhood recommends the introduction of proactive guidelines for care to reduce HD and increase breastfeeding rates. For the study, an audit was carried out of admissions to one UK hospital over a 15-month period. Following this initial audit, new guidelines for care were introduced and a second audit was carried out six months later which showed a reduction in the incidence of HD and an increase in breastfeeding rates.

About Us
You are receiving this e-CIMS News to keep you up to date on CIMS' activities, research, policy issues, and conferences that may be of interest to you. If you have suggestions on what resources or information you would like to see in upcoming editions of e-CIMS News, please e-mail us at info@motherfriendly.org.

CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.