Health-Care Reform for Childbirth

Abstract

In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.

Wendy C. Budin

Editor

Lately, one cannot pick up the newspaper, listen to the radio, or watch television without being bombarded with news stories about health-care reform. Our nation's health care is in crisis. In addition to conversations among health-care consumers, the topic of health-care reform is currently occupying center stage among lawmakers and their constituents, as well as the current administration in Washington, D.C. What does this have to do with childbirth? We know that childbirth is the number one reason for hospitalization in the United States. Most consumers, legislators, and health-care stakeholders agree that all pregnant women should have access to high quality, affordable health care.

In order to improve health care to childbearing women, we must advocate for comprehensive maternity coverage for every woman. Adequate health insurance will allow all pregnant women to receive essential prenatal care. Quality prenatal care often leads to healthier pregnancies, healthier babies, and lower costs.

Health-care reform must promote, support, and protect natural, safe, and healthy childbirth. Because most childbearing women and their newborns are healthy and at low risk for complications, it is important that women have access to appropriate quality health care in a safe environment that supports a woman's innate ability to give birth, breastfeed, and begin to mother her newborn. In such an environment, overuse of costly interventions that interfere with the normal process of labor and birth are avoided except in the rare situations in which women are at high risk for serious health problems.

Health-care reform must have an emphasis on promoting wellness, prevention, and appropriate referral and treatment as needed. There is a need for expanding the pool of qualified midwives and family physicians to provide care to low-risk pregnant women. Research has consistently demonstrated positive outcomes for these care providers as compared to specialists.

There is also a need for expanding access to freestanding birth centers. Healthy women who give birth in U.S. hospitals today are more likely to experience interventions such as induction, routine electronic fetal monitoring, restricted movement, and other procedures that are often associated with escalating cesarean surgery rates. Women who choose planned home birth must be assured access to qualified midwives with appropriate, timely medical backup and coordinated care across health-care settings, if needed.

Breastfeeding must be promoted and supported. On June 11, 2009, Representative Carolyn B. Maloney (NY) and Senator Jeff Merkley (OR) reintroduced the Breastfeeding Promotion Act in both houses of Congress, to provide a unified national policy to keep mothers, their children, and their communities healthy. This act includes four provisions aimed at increasing the rates of breastfeeding in the United States. If enacted, the legislation would protect breastfeeding under current law, provide tax incentives, seek minimum safety standards for breast pumps, and allow breastfeeding equipment and services to be tax deductible. Organizations, including the United States Breastfeeding Committee, are advocating for the passage of this legislation.

So, what can you do? Stay informed. Get involved. Be heard. Writing to your legislator is an easy and effective way to share your opinions about important issues affecting childbearing women and their families.

IN THIS ISSUE

Continuing the practice of advancing the Lamaze International mission to promote, support, and protect natural, safe, and healthy childbirth by sharing birth stories, this issue's “Celebrate Birth!” column features a new mother's story of her son's birth that was shared via an e-mail message from her hospital room to her prenatal yoga instructor, Ann Israel, less than 24 hours after giving birth. In her fresh recollections of her labor and birth, Tracy Posner describes how she was able to work with her labor, was well supported by her husband and doula, and negotiated successfully with the hospital staff to have a safe, healthy birth. She describes how difficult labor is and the ways in which comfort and support strategies help women manage contractions.

In this issue's guest editorial, “Home Birth Matters,” Elizabeth Armstrong critically evaluates recent peer-reviewed studies that contribute to the evidence base supporting home birth as a safe option for low-risk women attended by skilled midwives. Armstrong also shares the factors that went into her personal decision for choosing a home birth and makes a compelling case for why home birth is an important cultural touchstone in the landscape of American maternity care.

The featured articles in this issue span diverse topics that include labor support, fathers' perspectives on prenatal education, and the sensitive topic of parent involvement in end-of-life care and decision making in the newborn intensive care unit. In their article, “Factors Associated With Labor Support Behaviors of Nurses,” Samantha Barrett and Mary Ann Stark present findings from a secondary data analysis designed to examine individual and institutional factors associated with labor support behaviors. Although labor support is known to enhance the progress of normal labor and nurses are encouraged to provide labor support, many individuals encounter barriers to the practice of labor support. Age and experience were individual factors related to labor support behaviors of nurses, with older and more experienced nurses providing more labor support. Institutional factors associated with labor support were lower rates of epidural analgesia use and cesarean surgery. Barrett and Stark conclude that birthing families should understand how the birth environment may influence the care that nurses give during labor and that choosing an environment that supports normal birth may be the best place for receiving supportive nursing care during labor.

Swedish authors Kerstin Erlandsson and Elisabet Häggström-Nordin describe findings from their phenomenographic study designed to capture fathers' conceptions of parental education topics, illuminated by their experiences as primary caregiver of their child immediately following birth. Categories derived from the data showed parental education emphasizes the importance of normal birth, defuses the issue of complicated births, and preserves traditional gender roles. Erlandsson and Häggström-Nordin conclude that the study's results may facilitate efforts to integrate fathers into parental education toward the aim of achieving parity between mother and father in their role as parents.

In a thought-provoking discussion of a sensitive topic, “Parent Involvement in End-of-Life Care and Decision Making in the Newborn Intensive Care Unit,” Lacey Eden and Lynn Clark Callister discuss the increasing survival rates for very preterm and critically ill infants and examine the complex ethical issues for health-care providers and parents who face the challenge of making end-of-life decisions for these newborns. The purpose of this integrative literature review was to evaluate parental involvement in end-of-life care and decision making for their infant in the newborn intensive care unit. Findings revealed that establishing good relationships and clear communication between health-care providers and parents builds trust and eases stress placed on parents making decisions about the care of their infant. Eden and Callister describe palliative care programs that provide support for parents and facilitate their decision making. They propose that educating nurses on how to provide end-of-life care may also help improve support for parents during this difficult time.

In this issue's “Tools for Teaching” column, Brenda Broussard and Anne Broussard, two nurse educators/nurse-midwives who have been involved for over 10 years with a grant-funded parenting and childbirth education program for pregnant teens, provide helpful tips on grant writing for childbirth educators. The authors discuss how obtaining funding to support community-based childbirth education programs can be a challenge for childbirth educators who may have little grant-writing experience. They suggest grant-funding sources and present the basic steps involved in the grant-writing process as well as the importance of follow-up evaluations and reports.

Amy Romano, Andrea Lythgoe, and Henci Goer reprise recent selections from the Lamaze International research blog, Science & Sensibility, in their column “They Said So on the News: Parsing Media Reports About Birth.” Each selection discusses shortcomings in the news media coverage of childbirth issues. Romano, Lythgoe, and Goer demonstrate how to identify misleading claims in the media and highlight how childbirth educators can apply a common-sense approach and careful fact checking to help women understand the whole story.

We welcome Stacie Bingham as a new columnist who joins Teri Shilling in coordinating The Journal of Perinatal Education's popular “Media Reviews – New Resources for Childbirth Educators and Parents.” In this issue's column, reviewers offer perspectives and comments on a variety of new media resources for childbirth educators and for expectant and new parents. The books, CD, and DVDs reviewed in this issue's column address the following topics: natural, safe, and healthy birth practices; doula care; breastfeeding; empowering women to make healthy lifestyle choices during pregnancy; encouraging mothers to bond with their babies before birth; and fathers' and partners' supportive role during labor and birth. The media resources reviewed in this issue's column include Breastfeeding with Comfort and Joy: A Photographic Guide for Mom and Those Who Help Her by Laura Keegan; The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, Third Edition by Penny Simkin; Prenatal Peace & Calming, a CD created and produced by Jill Wodnick; and Your Healthy Pregnancy: 3-Volume Set produced by InJoy Birth and Parenting Videos.