Labor induction

Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”

January 14th, 2016

Hello Mamas,

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.

Read the entire Issue Brief Here. For more information, visit Choices in Childbirth or Childbirth Connection.




Mamas on Bedrest:Unnecessary Medical Interventions in Labor and Delivery May be Putting Mothers, Babies at Risk

January 20th, 2015

Greetings Mamas!

I am happy to present to you a podcast interview with Carol Sakala, Director of Childbirth Connection Programs for the National Partnership for Women and Families. She has graciously stopped by today to share with us a landmark comprehensive report put out by Childbirth Connection and National Partnership for Women and Families called, The Hormonal Physiology of Childbearing and Its Implications for Women, Babies and Maternity Care. This report is unlike any other report on maternity care to date. Compiled by Dr. Sarah J. Buckley, the report is a review of over 1100 research papers and reports examining the best practices for maternity care and the best practices that protect and enhance the hormonal systems that are the most essential and influential in pregnancy and childbearing.

The report consists not only of the research and the evidence for each practice recommended, Childbirth Connection has also developed extensive patient and clinician resources that are available for free on the Childbirth Connection website. I am so grateful to Ms. Sakala for taking the time from her busy schedule, on a holiday, to explain the particulars of the report and to share some particular nuances that are beneficial to Mamas on Bedrest.

I apologize in advance for the recording. My microphone is more powerful than I thought picking up background noise from outside despite closed doors and windows. Deleting the noise caused some of the interview to be lost. So bear with the noise, in the beginning as the information is just too good to lose.

Mamas on Bedrest: No more C-Sections for Breech Births?

July 8th, 2013

If you are a mama in Australia or New Zealand, you may well be advised to have a vaginal birth-even if your baby is in breech position.

Reported in The Canberra Times by Kate Hagan, Revised guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists are advising that vaginal births are possible with breech presentations and should be attempted in appropriate women.

While this is a 180 degree shift from previous position statements, members of the college are recognizing that more breech presentation infants could have been born vaginally if health care staff were properly trained. According to College vice president Steve Robson,

“Only 3% of babies were in the breech position late in pregnancy and most were delivered by cesarean section, meaning few young doctors had the skills to perform vaginal births.”

In Australia and New Zealand, vaginal deliveries of breech births dropped from 23% in 1991 to 3.7 % in 2005 due to the shift to cesarean sections.  The shift occurred after an correspondence published in The Lancet in 2000 cited fewer risks delivering by cesarean sections. However, many doctors skilled in breech delivery question the study and the reported results.

Dr. Kobus du Plessis, a physician trained in South Africa, is particularly skeptical of the studies and is now training young doctors and midwives to attend breech births. According to du Plessis,

“Most deliveries are hand-off with breech births, and if all the criteria are fulfilled most of the time we don’t have to do anything. The reason you need experience, and the thing most people afraid of, is the head getting stuck.”

This is great news for mamas and babies worldwide. Whenever one nation or even one group makes major headway in a given treatment or technique, its not long before others seek them out to learn the skills and to disseminate the information and “technology”. Interestingly, in this case, it isn’t technology being sought, but lost skills and as Dr. du Plessis says, “lost art”. Long ago, physicians and midwives both used Leopolds Maneuvers and other manual manipulations to turn babies and facilitate vaginal births. As technology became more sophisticated, medical training became more focused on the technologies, setting aside many of the more “basic” skills needed.

And while technology is good, we are all becoming more aware that technology is not a suitable replacement for nature. The intricate interplay between mother and baby stimulating labor and delivery, passage of the infant through the birth canal and the immediate interaction between mother and baby in the immediate post partum cannot be replicated or substituted.  Removing these critical interactions via induction, cesarean delivery and by separating mama and baby in the immediate post partum are now being noted to be detrimental and the practices halted.

How will this affect births in the United States? Hopefully, obstetricians and midwives will take notice of the changes being made in Australia and New Zealand and will follow suite. Given the Cesarean Section rates and the maternal and infant morbidity and mortality rates, we need to make changes in this country. It would certainly be nice to keep it simple and do things as much in line with nature as possible.