Monday, May 11, 2015

10 Top ways to effect change in maternity care

In a retrospective analysis of maternity care practices in the US, much progress has been made.
However, there is still much work to do.  In spite of all of the progress, the US still ranks too high in maternal morbidity and mortality and infant morbidity and mortality.

History shows us that while the cesarean section rate and medical intervention rates rise, the risks to mothers and babies have also risen.  Therefore, it becomes an imperative for professionals to have the most updated evidence-based information to assure consumers that best practice is being achieved.

Become educated yourself.
Identify several main topics that need to be improved in your community such as VBAC rates, cesarean section rates, breastfeeding rates.  Become the expert on just a few topics, making notes of the evidence and the source of the information.  Make certain that the research is no older than 3-5 years for optimum accuracy

Understand why there may be a lack of evidence in the hands of professionals
When medical professionals finish their education, most are only required to obtain a certain number of hours of continuing education during a specified length of time.  This can be as little as 24 hours in a 3 year period.  Some even less.  So is it any wonder that once professionals leave school, they are unaware of the latest evidence?  Also realize that medical and nursing school have limited time to teach students life saving techniques.  Unfortunately, facts about physiologic birth and breastfeeding are not stressed;  in some cases, are not even addressed.

Create an environment for promoting evidence.
Once you have become educated, decide on a plan for promoting and presenting evidence.  Before this plan can be created, your target needs to be identified.  Will you present the information to professionals? Or to parents?  If you will be addressing professionals, understand how professionals learn: through presentations and workshops that carry CMEs or CEs.  These are continuing education credits recognized by physicians and nurses.  Or will you be helping parents become more educated?  Becoming a certified childbirth educator or linking up with one can increase your chances of reaching parents.

Identify resources of evidence based information
Finding the evidence is relatively easy if you have access to a computer.  Websites such as the Cochrane Database or Childbirth Connection, National Institutes of Health or March of Dimes can be great sources of information.  When reading articles, look for research that has been quoted.  Avoid op ed pieces and blogs where only opinion exists

Provide the evidence in plain language to the consumers
Most medical evidence is written in medical language that the average person may not be able to comprehend.  First, identify the educational level of the consumers that you wish to reach.  Second, translate the evidence into the language for those consumers.  Attention to literacy level and the use of appropriate photos and graphics adds to the learning process.

Provide the evidence to the medical professionals
Professionals are busy.  When providing the most up-to-date evidence based research, present the information in short bites and include the names of the journals.  Often if professionals see that their own journals are advocating for best practice based on new research, the possibility of change improves.  However, change in the medical profession is always very slow.

Use all types of social media to present the evidence
History and research demonstrates that it is the power of the consumer that changes medical care and in particular, maternity care.  During the natural childbirth movement of the 1970s, childbirth education made a huge impact on expectant parents.  Today, most expectant parents are online and frequent social media.  Present evidence-based information via all social media, using Tweets, memes, infographics, qr codes, websites and more!

Volunteer on the local, state and international level
From local Birth Networks to organizations such as the International Childbirth Education Association or Coalition for Improving Maternity Services, need volunteers to help maintain support for those who are promoting the evidence and also provide a more unified voice for best practice.

Be professional in presentationWhereas you don’t have to wear a suit or lab coat to present information to either groups, parents or professionals, you do have to present a professional appearance to garner respect.  Know the group you are working with and dress, speak and act appropriately.  If in doubt, contact a peer for an honest opinion.

Don’t give up
Many childbirth professionals become burnt out from years of advocating for physiologic birth and better birth outcomes.  History again shows us that the energy in the 60s and 70s gave way to the apathy of the 80s,  and then the high rates of interventions in the 90s and 2000s.  We cannot give up nor can we promote evidence based maternity care in the old ways.

The evidence is out there – protect it and promote it.

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