1. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a National Strategy Tina Johnson, CNM, MS American College of Nurse-Midwives

2. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Goals of ACNM’s Normal Birth Initiative Promote healthy, normal physiologic birth as the standard of care for “low risk” women Identify the evidence, care processes and outcomes, quality indicators, systems changes, and outreach needed to support and promote the value of healthy, spontaneous labor and birth within the healthcare system and to the general public

3. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Prenatal care that “Expects Trouble” “Safety” is ensured if birth takes place in hospitals with an obstetrician “Intervention intensive” labor and birth is best Fear of litigation Intense fear of labor and birth Rising maternal mortality and cesarean rates Cultural Context of Birth in the US

4. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Induction (41%)/Augmentation (31%) Intravenous fluids (62%) EFM (94% continuously in 2006) Restrictions movement (57%), eating (79%) drinking (60%) Epidural (67% of vaginal births) Urinary catheter (47%) Instrument delivery (11%)/episiotomy (17%) Cesarean (31%) Listening to Mothers III (2013) www.childbirthconnection.orgwww.childbirthconnection.org Reality of Birth in the US

5. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved  Highly technological procedures in childbirth have been normalized without an associated improvement in outcomes.  Many different countries have created statements defining and describing “normal” birth, yet at that time, the U.S. did not have a similar, consensus- driven statement about this fundamental concept in birth. Context of “Normal Birth”

6. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved A shared culture of dialogue, collaboration, and teamwork

7. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Formation of the Physiologic Birth Task Force Consensus Statement Consensus Statement Steering Committee Advisory Committee Advisory Committee Sub- Committees

8. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Consumer Statement about Normal Physiologic Birth

9. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Women have lost confidence in their ability to give birth under their own power Standard maternity care is not evidence-based and actually increases risk Provides evidence based information to consumers about labor and birth Increase women’s understanding of normal birth Normal Birth Consumer Statement

10. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved

11. Endorsers

12. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing Documents to Introduce Normal Birth to Hospital Quality Personnel and Insurers

13. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Quality patient care in labor and delivery: A call to action. J Midwifery Womens Health. 2012;57(2):112-113.

14. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved NQF 14 Perinatal and Reproductive Health Measures JC 5 Perinatal Care Core Measures

15. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Joint Commission: Perinatal Care (PC) Core Measure Set PC-01 Elective Delivery PC-02 Cesarean Section PC-03 Antenatal Steroids PC-04 Health Care- Associated Bloodstream Infections in Newborns PC-05 Exclusive Breast Milk Feeding Improvable with Physiologic Care

16. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved To Date… White paper about normal birth being submitted for publication Documents targeting hospital quality personnel and insurers are in final stages of development and design

17. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved PROMOTING NORMAL, PHYSIOLOGIC BIRTH: Developing a Tool Kit for Maternity Care Professionals

18. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Target: 1) Clinicians and hospital staff at the point of care 2) Maternity unit leadership Scope: Implement care process improvements that support, promote, and facilitate physiologic birth through dissemination of useful, actionable resources and case studies from exemplars

19. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved Development of the Tool Kit Founded on the Consensus Statement Encouraged engagement vs. alienation Whole scale change vs. steps at a time Searchable Easy access from a busy unit Aimed at the front line user with background for administrators and systems

20. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved BirthTOOLS : Menu of Change For each focal area, the toolkit will include: – Review of evidence – Model unit policies – Clinical decision support tools (e.g. algorithms, checklists) – Guidelines and tools for auditing performance – Educational resources for clinicians and/or consumers

21. Copyright © 2013 American College of Nurse-Midwives Inc. All Rights Reserved