- Describe your topic.
- The topic is childbirth education. Specifically, we want to know if participation in evidence-based childbirth education reduces the likelihood of a primary cesarean delivery (a first cesarean delivery regardless of the number of previous deliveries) for low-risk women. Secondary outcomes include the effects of this education on knowledge acquisition, self-efficacy, involvement in decision-making, perceived control, as well as cervical dilation on hospital admission and method and amount of pain relief.
- Describe why this topic is important.
- The effects of childbirth education on birth outcomes including mode of delivery remain largely unknown despite being widely recommended for pregnant women and their partners by healthcare professionals in the United States. A specific program designed to teach women evidenced-based birth practices may decrease the incidence of primary cesareans in low-risk women by decreasing incidence of early admission to the hospital; increasing women's confidence, feelings of control, and empowerment; and decreasing their anxieties about labor and birth. The safe reduction of cesarean delivery (CD) rates in the United States remains a national public health priority because of safety, quality, and cost concerns. While there is a lack of consensus on a single optimal level of cesarean delivery, population rates greater than 10-19 percent suggest overuse and are not associated with improved maternal or neonatal outcomes. By 2016, the overall CD rate in the United States reached 31.9 percent, up from 21 percent in 1996. The low-risk cesarean rate in 2016 was 25.7 percent above the Health People 2020 goal of 23.9 percent. Delivering a baby by cesarean section will most likely lead to future cesareans. After a primary cesarean, only 10 percent of women will have a subsequent vaginal birth. Cesarean birth increases the risk of infant and maternal morbidity, requires longer in- and out-patient recovery periods, and costs the patient and healthcare system almost twice as much as vaginal deliveries. The average cost of a cesarean birth is 50-percent higher than a vaginal birth (Cesarean: $27,866 vs. Vaginal: $18,329). CDs under Medicaid, which account for approximately half of all U.S. births, costs $13,590 vs. Vaginal: $9,131 Childbirth Connection, 2013). Many women do not understand the potential complications of cesarean birth even when they undergo the procedure. The recently published survey, Listening to Mothers in California, describes the experience of women who feel “pressured” to undergo labor interventions that can lead to primary cesarean birth. There is a need to document evidence-based measures that can be taken (such as prenatal childbirth education) to better engage women in shared decision-making, to improve outcomes, decrease costs, and to improve birth satisfaction.
- Tell us why you are suggesting this topic.
- Routine birth procedures without medical indications can lead to a cascade of interventions that may conclude with an unplanned primary cesarean birth. The American College of Obstetricians and Gynecologists (ACOG) has called for limiting routine interventions to prevent primary cesareans. According to ACOG’s 2017 Committee Opinion #687 Approaches to Limiting Intervention During Labor and Birth, many common obstetric practices have limited or uncertain benefits to low-risk women in spontaneous labor. Empowering women to engage in shared decision-making with their healthcare providers is the cornerstone of childbirth education. Knowledge of the evidence-based risks and benefits of common labor interventions is necessary for women to engage in such discussions. At least one study showed that those who attended childbirth education classes and/or had a birth plan increased their likelihood for a vaginal delivery.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- If the review identifies evidence-based childbirth education as effective in reducing primary cesareans, it will help promote expectant mothers’ evidence-based education regarding regard to labor interventions, increase the role pregnant women and healthcare providers have in shared-decision making, and encourage practitioners, payers, and hospitals to integrate formal childbirth education programs into quality-improvement programs. Lamaze International is the only childbirth education certification that meets the National Commission for Certifying Agencies’ rigorous accreditation standards. This includes a continuous education program and practice within the scope of Lamaze essential content. A Lamaze Certified Childbirth Educator (LCCE) incorporates the following evidence-based Six Healthy Birth Practices into all birth classes: • Let labor begin own • Walk, move around and change positions throughout labor • Bring a loved one, friend or doula for continuous support • Avoid interventions that are not medically necessary • Avoid giving birth on your back and follow your body's urges to push • Keep mother and baby together - It's best for mother, baby and breastfeeding.
- How will you or your group use the information from a new evidence report?
- Lamaze International is an education and advocacy organization that uses best practices to promote safe and healthy birth. With evidence that a childbirth education program can reduce the primary cesarean birth rate, Lamaze would work to increase access to comprehensive prenatal care models that include evidence-based childbirth education. As in the past, Lamaze would collaborate with other birth-related professional organizations who share our goal of improved birth outcomes, especially in populations that lack access to comprehensive prenatal care. In doing so, Lamaze International would help these populations understand the role that evidence-based childbirth education and shared decision-making can play in improved outcomes. Lamaze International would also lend support to state and national policymakers to draft legislation that would establish and increase access to comprehensive prenatal care models that include evidence-based childbirth education.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Lamaze International has a broad communication strategy that includes our parent and professional websites (Lamaze for Parents www.lamaze.org and Lamaze International www.lamazeinternational.org, respectively), social media, The Journal of Perinatal Education, and the Inside Lamaze newsletter. Members attend a yearly conference and biennial advocacy summits. Lamaze International regularly seeks to collaborate with, and disseminate, information to organizations that promote better birth outcomes across all populations of childbearing families. Some of these organizations include professional societies such as ACOG; the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); health, breastfeeding and prenatal care-focused organizations such as March of Dimes (MOD); Doulas of North America (DONA); the National Partnership for Women and Families, the United States Breastfeeding Committee (USBC), Every Mother Counts, and Black Moms Matter. As well, we will share information with initiatives such as the National Quality Forum, AIM, California Quality Initiative; private and public payers; state and national policymakers; and local, state, and national prenatal and maternal health programs. Lamaze International would disseminate information from an evidence report to members by incorporating its contents into our education curriculum, childbirth educator resources, Lamaze Certified Childbirth Educator certification study guide materials, Lamaze parent education materials, research papers, policy briefs, and other Lamaze publications.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Yes, as noted above in question #6, we have collaborated birth-related organizations including ACOG, AWHONN, DONA, MOD, the National Partnership for Women and Families, USBC, Every Mother Counts, and Black Moms Matter. Other healthcare organizations that could benefit from this evidence report include the National Quality Forum, AIM, the California Quality Initiative, private and public payers, state and national policymakers, and local, state, and national prenatal and maternal health programs.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Professional Society Member
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Lamaze International
- Please tell us how you heard about the Effective Health Care Program.
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