Monday, January 03, 2011

The Evidence says: Childbirth Education Is A Vital Part of Maternity Care

The Healthy People 2020 initiative for Maternal Child Health is supported by clinical recommendations from the US Preventive Services Task Force (USPSTF).  The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).
The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."
In reading through the Healthy People 2020 initiatives, it is plain to see that many of the initiatives could be accomplished with comprehensive childbirth education classes, taught by certified childbirth educators, and enthusiastically and positively promoted by physicians and midwives early in the pregnancy of every woman.
The very fact that Healthy People 2020 initiative MICH-12 calls for an increase in the proportion of pregnant women who attend a series of prepared childbirth classes is proof enough that childbirth education classes are important.  Numerous studies (available with abstracts) are listed on the US National Library of Medicine/National Institutes of Health website, extolling the virtues of childbirth education classes in improving maternity care.  However, not all providers of childbirth education classes devote curriculum to the dissemination of evidence-based information.
The U.S. maternity care system, with the escalating cesarean section rate, increase in near term newborns from an increase in elective inductions,  and a standard of maternity care that is intervention based rather than health based, is truly at a cross roads.  We can no longer sit back and debate whether maternity care is evidence-based.  We have seen that over and over again, in most cases, it is not.
Judith Lothian wrote in the winter 2009  issue of the Journal of Perinatal Education, “It is a challenge to present the “best evidence” when hospitals provide care that is decidedly not evidence-based. Childbirth educators and nurses too often feel pressured to encourage women to comply with hospital policies and routines or are pressured to withhold information or present information in ways that do not challenge women's prior thinking. Our mandate to assist women in making informed decisions, including making them aware of their right to informed refusal, creates never-ending dilemmas for many childbirth educators (as well as many nurses, midwives, and physicians). It is extremely difficult to move from principles to practice!
What can be done to “fix” this seemingly impossible situation?
We need only to take a brief visit back to the 1960s and 1970s when maternity care faced similar challenges. 
1)      Childbirth education must be taken back by certified childbirth educators (either nurses or non-nurses).  Not all nurses have the qualities to be an educator; conversely, not all educators need to be nurses.  Medical schools and nursing schools prepare the students for crisis intervention and rarely prepare students to work with the laboring female body in a physiologic manner.  To this end, those who teach childbirth education absolutely must be trained and certified by organizations who will give them the knowledge of physiologic birth.
2)      Childbirth education must be community based so that the freedom of sharing unbiased, evidence-based information is preserved.  Fear of job loss is evident in areas where childbirth education is taught by hospital employees.  Failure to conform to non-evidence based mandates ultimately result in sanctions or job loss.
3)      Childbirth education must be taught with a standard of credibility, excellence and adherence to the evidence, regardless of the organization of certification.
4)      Childbirth education must have at its core the right of every pregnant women to base her decision-making during pregnancy, birth and parenting on informed consent.  With journals dedicating entire issues to informed consent, numerous conference devoting speakers to teach about informed consent and federal acts/professional practice guidelines defining and mandating informed consent, the inconvenient truth is that not every American woman has the opportunity to exercise this right during childbearing.
5)      Childbirth education must strongly advocate for women as it did in the 1960s and 1970s.  Childbirth education must NOT be adversarial. We must use a variety of marketing strategies to campaign for healthier mothers and babies through evidence based maternity care.  We must shine the light of truth on the fact that U.S. maternity care is not evidence based; that it is based on old information, convenience and intervention. 

Contact your certifying organization and ask them what their Strategic Plan for 2011 entails. This is the best way to know if your organization is working toward this goal.  Then, take these five “musts” and see how you can incorporate them into your community.

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