Archive for the ‘Birth Center’ Category

Unveiling Nassau University Medical Center’s New Birthing Center

October 14, 2013

How many hospitals do you know of that offer waterbirth or fully support the midwifery model of care?  How many L&D departments are run by a chairman convinced that mother-friendly care is the gold standard that all hospitals should strive to provide to birthing women? While the answer should be “many” if not “all, “ImageImageImage the opposite is the norm.

As an Ecstatic Birth advocate and Choices In Childbirth (CiC) board member, I am often asked “Where can I have the best birth experience?” The majority of women aren’t comfortable with the answer “home.”  Yet the alternatives, birthing centers or mother-friendly hospital programs are sorely lacking.

This week, I  had the pleasure of accompanying CIC’s Executive Director Elan McAllister to a community outreach forum at Nassau University Medical Center where they are unveiling a new birthing center this fall. We were thrilled to discover that NUMC is is a bright light of hope in an otherwise dark landscape of birthing options on Long Island.

The forum began by acknowledging each and every midwife present with a rose in honor of Midwifery Week. This touching gesture set the stage for an uplifting panel of presenters where we learned that NUMC has successfully been integrating midwives and mother-friendly care into their labor and delivery program for years. We witnessed an incredible air of collaboration and mutual respect between the doctors and the midwives that work at NUMC.

In an era where it feels challenging to find consistent mother-friendly care in a hospital setting, NUMC provides a great model for how it can and does work. Their outcome statistics fully back the program up. They boast the lowest c-section rate on Long Island by far- (at 28.1% in 2011, they were the only hospital in the county with a rate below 42%).

Elan was invited to share CIC’s work, a large part of which involves advocacy to make sure that women have access to a full range of evidence-based best practices when choosing where and how to birth.  The last decade has been heartbreaking in the NY area as many programs that delivered mother-friendly options to women have closed down- despite the fact that all the evidence shows that such models deliver better outcomes for moms, babies, AND our health care system. CIC is currently undergoing a huge initiative known as the NYC Report to better illuminate the birth landscape and pave the way for better options; NUMC’s program is a prime example of what works.

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Sheila Kamara Hay is a writer, Ecstatic Birth advocate, CIC board member and super-mama to three little ones. She can be found writing about pleasure and childbirth at http://ecstatic-birth.com/

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New Research: Doula Support Reduces Odds of Cesarean Section by 40%

February 22, 2013

A new study entitled Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries” was released online last week in the American Journal of Public Health and is creating quite a stir within the childbirth community nationwide.  Paired with National Birth Center Study II, released last month by the Journal of Midwifery and Women’s Health,  it seems that the movement toward more choices in maternity care is gaining strength.  The National Birth Center Study provided evidence for increased access to midwifery care and birth centers by showing that women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean births compared to women who give birth at hospitals.

The new study on doula care compared childbirth outcomes of women insured by Medicaid who received doula support to those who did not.  Researchers at the University of Minnesota School of Public Health found that doula support reduced a woman’s odds of giving birth via Cesarean section by more than 40%.  They also found a decrease in preterm births of almost 20% in the doula supported group.

Past research has shown that doula support results in other positive birth outcomes, such as:

  • Increased initiation and duration of breastfeeding
  • Shorter labors
  • Less need for anesthesia or analgesia
  • Fewer vacuum and/or forceps births
  • Higher APGAR scores
  • Better mother-baby bonding
  • Less postpartum depression

The study goes on to discuss the possible cost savings to Medicaid programs if they were to provide reimbursement for doula services, since Cesarean sections are approximately 50% more expensive than vaginal births.  The researchers are hesitant to provide concrete numbers because costs and associated benefits would vary widely by state.

But since blogs aren’t held to the same high standards that research articles are, we decided to come up with a very approximate estimate, just for curiosity’s sake.

Number of births in US per year
Estimated Percent of US births covered by Medicaid
Estimated Number of US births covered by Medicaid
US Cesarean section rate (2010)
Estimated number of Medicaid-covered Cesarean sections in US
Percent of Cesarean sections prevented with doula support
Number of cesarean sections preventable through doula utilization
Difference in cost between Cesarean section and vaginal birth
Resulting savings to Medicaid programs per year
3,999,386
46%
1,839,718
32.8%
603,428
40.9%
246,802
$4,500
$1.1B

This very rough sketch of the money that Medicaid programs would save if every mother had access to doula support doesn’t take into account the considerable cost of providing that support.  If Medicaid reimbursed for doula care at $500, and offered support to every mom, the cost would be about $920M.  That would still yield a net savings, after reimbursement, of nearly $200M.  Not to mention all those better outcomes for mom and baby.

This seems (to us) to be one of those wonderfully poised, win-win initiatives that leads to both happier, healthier moms and babies and cost savings for a taxpayer-funded program.  What would happen if there was a campaign in every state to bring this issue to the forefront and get doulas for all women?  And are you willing to help?

Watch CiC’s Executive Director, Elan McAllister, discussing doula care on Huffington Post LIVE

Article Citation:

Backes Kozhimannil, K., Hardeman, R., Attanasio, L., Blauer-Peterson, C., & O’Brien, M.  (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries. American Journal of Public Health. e-View Ahead of Print.  doi: 10.2105/AJPH.2012.301201

Building Your Birth Team

July 27, 2012

Assembling your birth team will be one of the most important steps you take as you plan for the birth of your baby. If you aren’t convinced that your doctor or midwife shares your same birth philosophy now, you cannot expect their philosophy to match yours during labor, so carefully consider who you want to care for you and your baby on your baby’s birth day. In addition, research shows that having continuous labor support clinically benefits both women and infants, resulting in less use of pain medication, fewer obstetrical interventions and cesarean sections, shorter labors, higher rates of breastfeeding, improved mother-infant bonding, shorter hospital stays for babies, and more positive birth experiences overall.1

The purpose of last week’s Choices in Childbirth’s free Healthy Birth Choices Workshop: Building Your Birth Team—Focus on Support was to allow expectant parents hear from couples who thoughtfully assembled their birth teams and how their choices influenced their birth experience. Hopefully, by the end of the evening, participants developed a clear idea of how the care provider and continuous labor support person they choose can impact their birth experience, and are closer to determining which type of care provider and labor support people they want on their birth team.

Three new mothers attended the event to share their stories, and Mother-Friendly Care Provider and home birth midwife Cara Muhlhahn came to share her perspective on building a supportive team for birth. Collectively, they shared important lessons for expectant mothers and their partners who want to feel supported as they welcome their babies into their lives.

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