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Fw: e-CIMS News: Coalition for Improving Maternity Services Newsletter

Posted Feb 15 2011 11:08pm
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Sent: Monday, February 14, 2011 4:23 PM
Subject: e-CIMS News: Coalition for Improving Maternity Services Newsletter

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Denna L. Suko, MA
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e-CIMS News February 14, 2011
In this edition...
Top Experts to Share Success Stories
IRS and US Congress Support Nursing Mothers
Eliminating Elective Early Deliveries, a Call to Action
Making Informed Decisions about Induction of Labor
Despite Health Concerns, Cesarean Rate Continues to Rise
Steps to Reduce the Cesarean Rate in the United States
Doulas Help to Reduce Cesareans
HHS Sets Ambitious Healthy People 2020 Goals
ACOG Opinion on Planned Home Birth
Team Care Will Lead to the Best Birth Outcomes
For Expectant Familiees
Top Experts in Woman-Centered, Evidence-Based Maternity Care to Share Their Success Stories
Save $25 on your Reframing Birth and Breastfeeding conference registration when you register today (2/14/11) at

National maternity care improvement efforts are currently underway to provide optimal care, reduce costs and include mothers as key participants in making informed health care decisions. In a joint effort to promote these goals, the Coalition for Improving Maternity Services and the Breastfeeding and Feminism Symposium Series are hosting the " Reframing Birth and Breastfeeding: Moving Forward " conference, March 11-12, at the Sheraton Chapel Hill Hotel, Chapel Hill, North Carolina.
As part of the program, experts of nationally recognized quality improvement initiatives, Michele R. Lauria, MD, MS, Warren P. Newton, MD, MPH, Adam Zolotor, MD, MPH, Morgan Martin, MHA and Tami J. Michele, DO, OB/GYN, will share their success stories and show conference participants how to implement their programs in their own communities.

"We are delighted that these leaders in improving maternal-infant health will share their know-how and successes with the Coalition for Improving Maternity Services and Breastfeeding and Feminism Symposium conference participants," said Michelle Kendell, chair of CIMS.
In addition to an amazing 22 hours of CE programming for the March 11-12 conference program, we are thrilled to offer two pre-conference workshops on Thursday, March 10. Don't miss:
  • The Art of Mother-Friendly Labor Support for Nurses. This workshop provides education and training in evidence-based nursing care as documented in the Mother-Friendly Childbirth Initiative. The instructors will cover strategies that the labor and delivery nurse can use to provide mothers with safe, satisfying, and cost-saving care. 7 contact hours. $150 Registration.
  • HUG Your Baby. HUG Your Baby Training is an innovative approach to helping parents understand their baby's body language in order to prevent and solve problems around a baby's eating, sleeping, crying, and parent-child attachment. 6 contact hours. $100 Registration.
IRS and U.S. Congress Support Nursing Mothers

On Feb. 10, 2011, Senators Jeff Merkley (D-OR), Tom Harkin (D-IA), and Representatives Sander Levin (D-MI) and Carolyn B. Maloney (D-NY) issued a press release announcing that the Internal Revenue Service (IRS), at their request reversed its ruling that previously excluded breast pumps and other breastfeeding supplies from being tax deductible.

Last year the IRS had ruled that breastfeeding does not provide enough health benefits to qualify as a medical care expense under flexible health spending accounts. However, in a letter to the IRS the members of congress stated that breastfeeding has health benefits for mothers and infants and lowers the risk for many medical conditions for infants including asthma, respiratory illness, infections, leukemia, and type 1 diabetes. The members of Congress stated that the cost of breastfeeding supplies was a barrier to breastfeeding for many mothers and the decision of the IRS to reverse its ruling was "a great victory for nursing mothers everywhere"

To find out more about state breastfeeding laws see the National Conference of State Legislatures website .

Additional Resource: CIMS' Fact Sheet " Breastfeeding Is Priceless "


Eliminating Elective Early Deliveries
A national Call to Action

On Jan. 26, Leapfrog Group, a hospital quality watchdog, announced a national Call to Action to eliminate elective early deliveries . In partnership with Childbirth Connection and the March of Dimes, Leapfrog is working to share information about the importance of every week of pregnancy with women, purchasers, and others. The recently released Leapfrog Hospital Survey found that hospital rates of early elective deliveries range from less than 5% to more than 40%, which Leapfrog reports "is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community." In Science & Sensibility , Amy Romano reports "Leapfrog's voluntary database of elective early delivery rates stands to drive significant quality improvement."

Elective early deliveries contribute to the nation's high preterm birth rate, which is much higher than in other industrialized countries, and the significant health complications experienced by premature babies. Although the preterm birth rate continued its downward trend for a third straight year in 2009, the March of Dimes' recently released 2010 Premature Birth Report Card gave the U.S. a "D" grade as measured by Healthy People 2010 goals set at 7.6 percent. According to data from the Centers for Disease Control and Prevention (CDC), the preterm birth for 2009 was 12.18 percent of all births, marking the first sustained decline in this rate since 1981.

Studies suggest that along with physiological complications, late preterm and possibly early term deliveries may increase a baby's risk of brain injury and long-term neurodevelopmental abnormalities. On a positive note, the number of preterm births has declined by 5 percent since 2006.

The cerebral cortex - the part of the brain that controls functions such as cognition, perception, reason and motor control - is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. The March of Dimes has developed the Brain Card, a teaching tool to help expectant mothers understand the risks of not allowing labor to begin on its own, and recommends that all care providers take the time to educate expectant mothers about the risks of inducing labor and scheduling a cesarean for non-medical reasons.
Baby's Brain 

There are known strategies that can lower the risk of an early birth, such as smoking cessation, preconception care, early prenatal care, progesterone treatments for women with a history of preterm birth, avoiding multiples from fertility treatments and avoiding unnecessary c-sections and inductions before 39 weeks of pregnancy.

CIMS encourages you to do your part to help reduce preterm births by sharing these resources with expectant parents, your professional colleagues, and your social network. 
Helping Women Make Informed Decisions about Induction of Labor
CIMS wants women to have access to the full range of the risks and benefits of induction of labor so they can make an informed choice. Childbirth Connection recently unveiled a new Induction of Labor topic , which covers the benefits, harms, and appropriate medical indications for induction. It also provides tips, tools, and resources that women can use to discuss their options with their providers. This evidence-based educational resource is a welcome addition to the consumer-oriented resources on this pressing topic and will hopefully encourage women and providers to reduce the number of early deliveries.  

Despite Health Concerns, Cesarean Rate Continues to Rise
Final birth data for 2008 and preliminary 2009 figures , now available from the Centers for Disease Control and Prevention (CDC), confirm the U.S. cesarean rate's upward trend. The cesarean rate continued to climbfor a 12th consecutive year in 2008 to 32.2 percent of all births. The preliminary report for 2009 is based on 99.95 percent of births for the year, and the data show the cesarean delivery rate increasing for a 13th year in a row to 32.9 percent of all births.

Last year, the CDC confirmed that a cesarean is major abdominal surgery and is associated with higher rates of surgical complications and maternal re-hospitalization, as well as with complications requiring admission to a neonatal intensive care unit. Despite concerns about the health risks of cesareans for mothers and infants, physicians now perform more cesareans than ever. According to the preliminary 2009 data: 
  • The number of women who gave birth by cesarean is up nearly 60 percent since 1996.
  • Between 2008 and 2009 the number of cesareans increased for women of all age groups 20 years and older.
  • One out of two women 40 years and older had a cesarean delivery.
  • The rate was also up for all race and ethnicity groups but the highest increase, 3 percent, was in non-Hispanic black women.
For more information about the risks of cesarean section, please download the CIMS fact sheet .

Steps to Reduce the Cesarean Rate in the United States
Consortium on Safe Labor identifies practices to significantly reduce the U.S. cesarean rate
In " Contemporary Cesarean Delivery Practice in the United States ", by Zhang et al and the Consortium on Safe Labor, the investigators identified areas to significantly reduce the cesarean rate in the United States. The primary cesarean rate can be decreased by reducing induction of labor, avoiding cesarean delivery before active labor is established, and having a clear medical indication for performing a cesarean delivery. Additionally, increasing patient education on laboring for a VBAC, increasing access to providers who support VBAC, and actively working to increase the number of women who have a safe vaginal birth can reduce the number of routine repeat cesareans.

The study examined records from 228,668 births from 19 hospitals. Findings included:

    One in 3 women with a first pregnancy had a cesarean delivery. Scheduled surgery due to previous uterine scar was the number one reason given for cesarean sections and contributed to almost 1/3 of cesarean deliveries. Of women attempting vaginal delivery, 44% were induced and the c/s rate was twice as high as those with spontaneous labor. In first time laboring mothers, induced labors, and women attempting VBAC, a high percentage of cesareans were performed before the woman reached 6 cm of dilation. The diagnosis of 'failure to progress' was applied before the active phase of labor. One-third of cesareans performed during the second stage occurred at less than 3 hrs in first time mothers, and less than 2 hrs in women who had previously given birth. ACOG guidelines define arrest of descent when pushing extends greater than this waiting period in women who have an epidural, and 90% of those in the study had an epidural. 
Doulas Help to Reduce Cesareans
Every laboring woman deserves the support of an experienced birth professional
CIMS congratulates DONA International on the recent release of a new documentary, " The Essential Ingredient: Doula ," which features DONA founders and past presidents speaking on the origin and rationale of doula support complimented with visuals of treasured birth and postpartum moments. Every laboring woman can benefit from the support of an experienced birth professional. The following information is provided by BirthNetwork National and Citizens for Midwifery in " Mother-Friendly Childbirth - Highlights of the Evidence ", a summary of CIMS' widely-acclaimed "The Evidence-Basis for the Ten Steps of Mother-Friendly Care":

HHS Sets Ambitious Healthy People 2020 Goals in the Area of Maternal, Infant, and Child Health
On Dec. 2, the U.S. Department of Health and Human Services (HHS) launched Healthy People 2020 , an ambitious 10-year agenda for improving the nation's health, which put forth extensive guidelines and learning tools to assist communities, health professionals, coalitions, and states to reach these goals.

" Maternal, Infant, and Child Health " is one of 42 evidence-based health focus areas outlined by Healthy People and draws on the accomplishments of four previous Healthy People initiatives. According to HHS, the well-being of mothers, infants and children determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system.

Prenatal objectives for expectant mothers are to increase the number of pregnant women who receive early and adequate prenatal care, who attend a series of prepared childbirth classes and the proportion of mothers who achieve a recommended weight gain during their pregnancies. In the areas of pregnancy and childbirth, the national goals are to reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery), reduce cesarean births among low-risk (full-term, singleton, vertex presentation) women and reduce the rate of maternal mortality.

To improve the health of infants, Healthy People aims to reduce preterm births, reduce low birth weight, and reduce the rates of fetal and infant deaths. To promote the health of newborns and infants, Healthy People would like to see an increase in the proportion of infants who are breastfed, reduce the proportion of breastfed newborns who receive formula supplementation within the first two days of life, and increase the number of employers that have worksite lactation support programs.

To view benchmarks for maternal, infant, and child health and access learning tools to implement them, visit the Healthy People 2020 website .
ACOG Issues Opinion on Planned Home Birth Based On Discredited Study
On Jan. 20, The American College of Obstetricians and Gynecologists issued a press release announcing the publication of Committee Opinion Number 426, "Planned Home Birth," in which ACOG warns that babies are two-to-three times more likely to die when women give birth at home and women who are considering a home birth should be warned of this fact. The Committee Opinion was published in the February 2011 issue of Obstetrics & Gynecology .

ACOG issued this unfounded alarm based on the deeply flawed Wax study . ACOG also believes that hospitals are the safest place to give birth.

The credibility of the Wax study had already been seriously questioned.

In an unpublished joint letter to Time Magazine coordinated by Our Bodies Ourselves, medical professionals stated, "All reliable data on home birth midwifery in regulated and integrated systems like the Netherlands and Canada suggest that home birth is safe for the baby and associated with significant health benefits for the mother."

The Wax study had also been thoroughly dismantledin an article by Amy Romano for Science & Sensibility .

ACOG's declaration that "it respects the right of a woman to make a medically informed decision about delivery," becomes highly suspect when the leading OB/GYN organization resorts to issuing misinformation on which women are expected to make an "informed" decision.

ACOG lags behind other professional obstetrics associations when it comes to collaborating with midwives who attend home births and respecting women's right to choose where and with whom they want to give birth. The Royal College of Obstetricians and Gyneacologists in Britain and the Society of Obstetricians and Gyneacologists of Canada support home birth as a safe option for low-risk women.

In its own response to the ACOG Opinion, the Midwives Alliance of North America (MANA) recommended, " is the responsibility of the entire maternal and child health care (MCH) community to promote access to care that promotes optimal health for mothers and infants. We have a responsibility to remove barriers to options that women choose...and work collaboratively as a team for the benefit of families."

CIMS urges others in the maternity care community to issue their own response to ACOG's Committee Opinion Number 426.
Team Care Will Lead to the Best Birth Outcomes
Working together to make birth better
The Dec. 2010, issue of the Journal of Family Practice featured an editorial by Jeff Susman, MD, titled, "It's time to collaborate-not compete-with NPs." In the article, Dr. Susman urges physicians to embrace a full partnership with America's advanced practice nurses, stating that "joining forces with APNs to develop innovative models of team care will lead to the best health outcomes." Dr. Susman's vision of a health system marked by collaboration and inclusivity among healthcare providers is a vision that is shared by CIMS.

We want to take this opportunity to showcase some of the ways that CIMS is working to foster greater collaboration among professionals and to disseminate timely and relevant information with readers, like you, who are working to improve the current state of maternity care.

  • Mother-Friendly Nurse Recognition : Honoring nurses who provide exemplary, evidence-based care.
  • The CIMS Annual Forum : We continually aim to improve the value and effectiveness of our educational programs for our coalition members and participants. Please join us for our next conference, "Reframing Birth and Breastfeeding: Moving Forward," March 11-12, 2011, in Chapel Hill, NC.
  • CIMS Membership : Since 2008, CIMS has called on those in the birth community that share our concern for the state of childbirth in the U.S. to unite with "One Voice" for evidence-based maternity care. Organizations and individuals from across the country have heeded our call for unity with their annual membership in CIMS.
  • The e-CIMS News : The e-CIMS News continues to deliver timely research and resources on topics relevant to the Mother-Friendly model of care.
  • CIMS on Facebook : We're leveraging social media opportunities to spread important news information and engage an even greater audience of like-minded individuals and organizations in mission-focused projects.
We invite you to explore our services, share information about them with your friends and colleagues, and help ensure the continued availability of these valuable resources in the coming year with your tax-deductible membership in CIMS .


"From the moment I attended my first birth while in medical school, I knew with every fiber of my being that the events of our births-both as mothers and infants-impacts us for the rest of our lives in ways that are both subtle and profound. Nothing is more important to our health or that of our newborns than the way in which we, as women, are supported during pregnancy, labor, birth, and postpartum. That's why I wholeheartedly endorse and support the life-changing work of CIMS."

~Christiane Northrup, MD, FACOG, a CIMS Lifetime Member and author of Women's Bodies, Women's Wisdom and The Wisdom of Menopause

As always, your feedback is important to us. Send your comments by email to .   

For Expectant Families

CIMS is delighed that InJoy Birth and Parenting Education has offered to provide resources for the e-CIMS section, For Expectant Families. We welcome and support collaboration among CIMS Organizational Members to further promote the Mother-Friendly model of maternity care. 


Research confirms that women who receive optimal support have easier labors, and are more fulfilled with their birth experiences. Feeling safe and cared for allows the brain to produce hormones that help labor progress - decreasing the need for medical interventions, and protecting both mother and baby from harm.


Penny Simkin, inspirational author, childbirth educator, birth counselor and co-founder of DONA, joined the Mother's Advocate Blog to discuss the importance of labor support 


"Women need to feel safe during labor, and in today's maternity care climate, the hospital is a rather strange place for most people - full of machinery and beeping machines. But also, there isn't much continuity of care. She may not have a doctor that she knows, or may not have a midwife that she knows if she's having a hospital birth - the nurses come and go. And so, there's not continuity. Having her loved one nearby gives her that continuity."

Read more of Penny Simkin's interview on the Mother's Advocate Blog .


Mother's Advocate Mother's Advocate, a service of InJoy Birth & Parenting Education, is dedicated to helping women have the healthiest, safest, most satisfying births possible. 




About Us
You are receiving this e-CIMS News to keep you up to date on CIMS' activities, research, policy issues, and conferences that may be of interest to you. If you have suggestions on what resources or information you would like to see in upcoming editions of e-CIMS News, please e-mail us at .
CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.
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Coalition for Improving Maternity Services | 1500 Sunday Drive | Suite 102 | Raleigh | NC | 27607
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