Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”January 14th, 2016
As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release:
“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”
“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”
The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).
- Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
- The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
- State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
- The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
- Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
- State legislatures should mandate private insurance coverage of doula services.
The bedrest debate continues as more and more studies are advocating treatment of the causes of bedrest in lieu of activity restriction. However, there are those that are convinced that bedrest is an effective treatment for preterm labor and prolongs pregnancy. Let’s take a look at the evidence.
For over 25 years, Judith Maloni, RN, PhD researched bedrest and found that the practice has no apparent benefit and has been shown to be harmful to pregnant women. Her publication, “AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth”(1), Maloni denounced the bedrest prescription because there was no evidence to support the practice.
In 2007. NASA released an article which showed that female astronauts in space lost bone mass and muscle mass and strength in as little as 2 weeks of inactivity, and the effects were even more pronounced at 60 days.(2) They recommended that if women do have to be on limited activity for an extended period of time, they should engage in a modified exercise program to maintain bone and muscle integrity.
The World Health Organization and Amnesty International have both denounced the bed rest prescription and have had sharp criticism of the United States-which boasts the highest costs of maternity care than any other country in the world, yet has some of the highest rates of complications, bed rest, interventions, cesarean sections and maternal and infant morbidity and mortality-to rethink their maternity care practices and to bring their maternity statistics in line with the rest of the world.
In 2013, physicians in the American Congress of Obstetricians and Gynecologists began questioning the practice of prescribed bedrest and Christina McCall, MD (3) and Joseph Biggio, Jr., MD (4) both called on their ACOG colleagues to stop the practice of bedrest citing the harm that is poses to pregnant women.
However, bedrest remains a mainstay in obstetrical practice. Here in Austin, the 2 major hospital systems each have large antepartum units which cater to women experiencing pregnancy complications. My colleague Angela Davids, founder of Keepemcookin.com, recently blogged about an article by Drs. Christine Piette Durrance and Melanie Guldi (5) in which the authors concluded after an extensive review of PRAMS (Pregnancy Risk Assessment Monitoring System) data of some 200,000 women, that limited inactivity does reduce preterm birth before 33 weeks by 7.7% and low birth weight infants (weighing less that 1500 grams) by 15.4%.
So what are mamas to think? Should they abandon bedrest? Remain on bedrest? Is there a way to not have to go on bedrest, to not encounter the complications that lead to the bedrest prescription?
At this juncture if you are a mama on bedrest, I WOULD NOT recommend abandoning the care plan that your provider has put into place for you. If you have questions about whether or not bedrest is necessary in your case, speak with your provider and voice your concerns. I am a firm believer that if you have hired (chosen) a provider for services, then you should follow their directions. Now if you are having reservations about being on bed rest, its efficacy and whether or not it is doing harm to you, you must have a candid conversation with your OB and get your questions answered so that you can make an informed decision.
I myself am a proponent of mamas getting off bedrest. I believe the way to do it is to help women to be in the best shape BEFORE they ever think about getting pregnant so that when they are pregnant they are strong and healthy. Many of you reading this may be saying, “Well fat lot of good that does me now!” I sense your frustration. There is nothing we mamas on bedrest do better than second guess ourselves! But what you did in the past (no matter how recent) is of no consequence. As Dr. Maya Angelou eloquently said, “When you know better, you do better.” You know better right now, so begin taking exquisite care of yourself right now! As much as possible,
- Eat healthy, nutrient dense foods.
- Drink lots of water (1/2 your current body weight but in ounces).
- Rest (I know that sounds ridiculous, but many mamas on bedrest are so stressed out they don’t sleep well and don’t rest. Your body is not only maintaining you, it is also growing another fully complete human being. That most certainly deserves a nap!
- Do stretches t keep your muscles supple and limber. (BedrestFitness!)
- Keep your spirits up
I don’t know what is to become of bedrest and the bedrest prescription. I do know for the nearly 1 million women who will experience bedrest, you have to take care of yourself. If you are in the Austin, TX area, look me up! I always enjoy mixing with mamas and would be happy to serve you.
How are you surviving bedrest? Share your tips and comments section below.
Judith Maloni, Ph.D. AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth (Biological Research for Nursing 12(2) 106-124)
Mark Ransford. NASA-Funded Study finds Exercise Could Help Women on Bedrest November 15, 2007
Christina McCall, MD, “Therapeutic” Bed Rest in Pregnancy, Unethical and Unsupported by Data”, vol 121, No.6 June 2013, 1305-1308
Joseph Biggio, Jr., MD.“Bed Rest in Pregnancy, Time to Put the Issue to Rest!” vol 121 No. 6, June 2013, 1158-1160
Christine Piette Durrance and Melanie Guldi. Maternal Bedrest and Infant Health.
I hope that you have had a chance to listen to our podcast interview with Ms. Carol Sakala, Director of Chilbirth Connection Programs for the National Partnership for Women and Families. In this podcast, Ms. Sakala shares with us the latest comprehensive report put out by Childbirth Connection entitled Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. This report outlines the hormonal physiology of pregnancy and childbirth and shows how many of the common interventions used during labor and delivery in the United States are not only detrimental to this delicate hormonal balance between mamas and babies, but potentially harmful to them both. They offer practice recommendations for clinicians as well as tips and tools for patients.
There are many documents that both patients and clinicians can download and print for free. These documents are available on the Childbirth Connection website. Below is a very informative infographic which shows the hormonal systems of pregnancy and how many of the common interventions used here in the United States are impairing those systems. It too is available for download and free for clinicians and patients to share. There is also an infographic with more detailed information for clinicians.