Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy Tina Johnson,

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

PROMOTING NORMAL, PHYSIOLOGIC BIRTH:

Developing a National Strategy

Tina Johnson, CNM, MSAmerican College of Nurse-Midwives


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


• 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

Cultural Context 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

Reality of Birth in the US

http://www.childbirthconnection.org/


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, consensus-driven statement about this fundamental concept in birth.

Context of “Normal Birth”


A shared culture of dialogue, collaboration, and teamwork


Formation of the Physiologic Birth Task Force

Consensus Statement

Steering Committee

AdvisoryCommittee

Sub-Committees



Developing a Consumer Statement about Normal

Physiologic Birth


• 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

Normal Birth Consumer Statement



Endorsers



Developing Documents to Introduce Normal Birth to

Hospital Quality Personnel and Insurers

Copyright © 2013 American College of Nurse-Midwives Inc. All Rights ReservedQuality patient care in labor and delivery: A call to action. J Midwifery Womens Health. 2012;57(2):112-113.


NQF

• 14 Perinatal and Reproductive Health Measures

JC• 5 Perinatal Care

Core Measures


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

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



Developing a Tool Kit for Maternity Care Professionals


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


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


BirthTOOLS :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
