e-CIMS News: Coalition for Improving Maternity Services Newsletter

e-CIMS News
August 17, 2009

In this edition...

ACOG Issues Controversial New Guidelines for Induction of Labor

Venerable Speakers to Headline the 2010 CIMS Forum

Sweeping Healthcare Reform Package Includes Critical Maternity Care Provisions

Upcoming Conferences

Honor Birth!

Transforming Maternity Care in New Jersey

For Expectant Families

ACOG Issues Controversial New Guidelines for Induction of Labor

The American College of Obstetricians and Gynecologists (ACOG) recently revised its 2003 guidelines for induction of labor.  The

ACOG Practice Bulletin, Number 107, published in the August 2009 issue of Obstetrics & Gynecology serves as a resource to help medical practitioners make decisions about appropriate methods of cervical ripening and induction of labor and their effectiveness.  At least two of the ACOG recommendations, inducing labor for "psychosocial" (non-medical) reasons and cervical ripening with the synthetic prostaglandin misoprostol (trade name Cytotec), differ from labor induction practice guidelines issued by the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the National Institute for Clinical Excellence (NICE), which drafts clinical guidelines in the U.K.
Induced labor puts women and babies at risk.  Compared to women who go into labor on their own, women who have an elective induction are at increased risk for intrapartum fever, instrumental birth, cesarean section, and are more likely to use analgesia including epidurals. Babies are at risk for irregular heart rate patterns, shoulder dystocia, neonatal phototherapy to treat jaundice, neonatal resuscitation and admission to a neonatal intensive care unit.  These risks are documented in CIMS' "Evidence Basis for the Ten Steps of Mother-Friendly Care" (see Step 6, pages 42-43).  According to the white paper "Idealized Design of Perinatal Care" published by the Institute for Healthcare Improvement, "Based on a review of U.S. medical malpractice claims, [the labor-inducing drug] oxytocin is involved in more than 50 percent of the situations leading to birth trauma."
These complications of labor also impact mother-infant attachment and the initiation and continuation of breastfeeding.  See "Breastfeeding is Priceless" (PDF). 
Although ACOG approves of "psychosocial" induction, NICE clinical guidance (PDF) warns that induction of labor has a significant impact on the health of women and their babies; it should be clinically justified and should not routinely be offered on maternal request except under extraordinary circumstances.  SOGC advises that there is no benefit to elective induction (PDF).  Because it is associated with potential complications, elective induction should be discouraged and only provided after women have been fully informed of the risks and of the inaccuracy of establishing gestational age.  ACOG approves of inducing labor at 39 weeks while SOGC states gestational age should be at least 41 completed weeks, and NICE guidelines state induction for non-medical reason can be considered at or after 40 weeks.
Misoprostol, an inexpensive synthetic prostaglandin, was developed and is marketed to prevent and treat gastric and duodenal ulcers.  The use of misoprostol for cervical ripening and induction of labor (off-label use) is approved by ACOG, but not recommended by either SOGC or NICE.  Misoprostol, also known as PG1, is not approved by the manufacturer for use in pregnancy (PDF).  Misoprostol is associated with excessive uterine contractions, fetal heart abnormality, hemorrhage, hysterectomy, and sometimes fetal death.  Both SOGC and NICE recommend its use be restricted to clinical trials.  For a more detailed discussion of the use of misoprostol for induction of labor, see Science & Sensibility.com.
Nearly one in four births in the U.S. is induced (PDF) and according to the Agency for Healthcare Research and Quality (AHRQ), although it is not entirely clear what proportion of these inductions are elective (i.e. without a medical indication), the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically-indicated induction.  According to Childbirth Connection's report, "Evidence-Based Care: What it Is and What It Can Achieve," the most common gestational age at birth among single babies in the U.S. is now 39 weeks rather than 40 weeks.

Consumer information on induction of labor is available from:

• The American Academy of Family Physicians' FamilyDoctor.org
• March of Dimes. See "Inducing Labor" and "Induction By Request"
• Lamaze International's "Care Practice #1: Labor Begins on Its Own" (PDF)

Venerable Speakers to Headline the 2010 CIMS Forum

The 2010 CIMS Forum will be held at the Radisson Hotel & Suites Austin-Town Lake, Feb. 26-27, in Austin, Texas.

As the U.S. stands at a crucial juncture for achieving national healthcare reform, CIMS will dedicate a significant portion of its 2010 Mother-Friendly Childbirth Forum to educational sessions that examine the current social-political climate and how maternity care is impacted by proposed healthcare reform policies.  In addition, several sessions will highlight evidence-based clinical practices that can improve maternal-fetal outcomes.  Confirmed speakers include Maureen Corry, MPH, Nancy K. Lowe, CNM, PHD, FACNM, FAAN, Penny Simkin, PT, Judy Norsigian, Raymond De Vries, PhD, Stefanie Antunes, LCCE, CD(DONA), Henci Goer, BA, Amy Romano, CNM, MSN, and Susan Jenkins, JD.

CIMS Forum participants will enjoy networking and socializing during a Welcome Reception on Friday evening and between educational sessions spanning two full days.  When not in session, conference participants will appreciate the Radisson's downtown Austin location, convenient to area businesses, the world famous 6th Street and many other area attractions. 
Start planning now to attend this important conference! Online registration to open in Fall 2009. For travel and lodging details, advertising and exhibiting opportunities, and to view presentations from our 2008 and 2009 conferences, visit www.motherfriendly.org.

Sweeping Healthcare Reform Package Includes Critical Maternity Care Provisions
What is being done to improve the care of America's birthing women?

As the healthcare reform debate heats up in town hall meetings across the country, far too few Americans are asking about the Congress' plans to improve the quality and value of healthcare for birthing women.  CIMS and many of its members and supporters are working to ensure that reform measures include critical maternity care provisions.

Here's a run-down of how CIMS' supporters are advocating on behalf of childbearing women:

• The American College of Nurse-Midwives (ACNM) recently announced
its endorsement (PDF) of the America's Affordable Health Choices Act of 2009, stating "H.R. 3200 takes positive steps toward ACNM's seven principles of health reform, particularly universal coverage, the reduction of health disparities, and the improvement of maternal and infant health."

America's Affordable Health Choices Act of 2009 (HR 3200) is also endorsed by Childbirth Connection, a national organization advocating for high quality maternity care for women, babies and families.  "This legislation goes a long way toward achieving Childbirth Connection's eight steps to reform maternity care (PDF) and ensures that all pregnant women and babies receive high quality, affordable health care," says Maureen Corry, Executive Director, Childbirth Connection. "This bill expands access to primary maternity care that supports a woman's innate capacity for birthing, breastfeeding and attachment, avoids overuse of medical services, and gives priority to prevention and wellness."

The American Association of Birth Centers is leading the charge in support of the Medicaid Birth Center Reimbursement Act (HR 2358/S 1423) to ensure Medicaid birth center facility fee payments to states.  Without payment of the birth center facility fees, birth centers in all states could be pushed to the brink of closure -- threatening access to this vital safety net for Medicaid mothers across the U.S.

The MAMA Campaign is a collaborative effort by the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC).  This partnership is now at work to gain federal recognition of Certified Professional Midwives so that women and families will have increased access to quality, affordable maternity care in the settings of their choice.

As a member of the National Quality Forum (NQF) and its advocacy alliance Stand for Quality, CIMS is helping to ensure that quality is at the heart of the healthcare reform debate. Stand for Quality, which includes more than 200 supporting organizations, recently noted that HR 3200 includes "multiple provisions that can support significant delivery system reform."  CIMS and others in Stand for Quality will continue to promote the findings and recommendations in the report "Building a Foundation for High Quality, Affordable Health Care: Linking Performance Measurement to Health Reform."  The recommendations are also supported by the American Association of Birth Centers, American College of Nurse-Midwives, and Childbirth Connection.

Upcoming Conferences (listed by date)

American Association of Birth Centers Annual Birth Institute "Change in Childbirth: Hope for a New Generation"

Sept. 3-6, Savannah, GA
Lamaze International 2009 Annual Conference "Celebrating the Magic of Normal Birth"
Oct. 1-4, Walt Disney World, FL
March of Dimes Symposium on Quality Improvement to Prevent Prematurity

Oct. 8-9, Washington, DC

International Childbirth Education Association 2009 ICEA International Convention
Oct. 15-17, Oklahoma City, OK
Birth Works International Conference "Primal Health: Global Lessons From the Womb"
Oct. 16-18, Portland, ME
Midwives Alliance 2009 "Rising Tide: Women, Midwives and the Future"
Oct. 22-25, Asilomar, CA
CIMS Mother-Friendly Childbirth Forum & Annual Meeting
Feb. 26-27, 2010, Austin, TX
Select presentations from the 2009 CIMS Forum are now available on our website.

Honor Birth!

Because pregnancy, birth, and the postpartum period are milestone events in the continuum of life...

Honor Birth was created as a way for you to honor a mother, her baby, her family, and anyone who gave her strength in her amazing journey to motherhood. Who inspires your passion for Mother-Friendly Care? 

Transforming Maternity Care in New Jersey

In 2007, New Jersey had a 38.3% cesarean rate--the highest in the nation.  CIMS has written a letter in support of Mother-Friendly Childbirth advocate Stacey Gregg and supporters of

New Jersey Maternity Care Worst to First 2010, a state-wide campaign to transform New Jersey's maternity care from the worst in the nation to the first by 2010.

For Expectant Families

Have a safe and healthy birth

New website offers free evidence-based materials for expectant parents and childbirth educators.

InJoy Birth and Parenting Education recently announced the launch of

mothersadvocate.org, a new website that provides free, easy-to-use information to help expectant parents have safer and healthier births.  Healthy Birth Your Way: Six Steps to a Safer Birth is the first product available and was co-produced with Lamaze International. A printable18-page booklet and seven online video clips teach parents how to have a better birth experience through six simple steps that have been shown to reduce intervention and cesarean surgery rates.  Lamaze's Six Healthy Birth Practices are based on recommendations by the World Health Organization and backed by extensive research that supports a woman's natural ability to give birth.  Mother's Advocate is a not-for-profit service of InJoy Birth & Parenting Education, Inc.  All products are provided at no charge and may be freely duplicated, distributed and used by individuals and educators in any teaching environment.

Both Lamaze International and Injoy Birth and Parenting Education are part of the CIMS Organizational Members Collaborative. The Collaborative was created to make a greater Mother-Friendly impact on maternity care by promoting and supporting CIMS' Organizational Members' projects.

ICAN Birth Class: Cesarean Prevention

Take charge of your birth and learn how you can reduce your risk of cesarean surgery by attending this 2-hour online session sponsored by International Cesarean Awareness Network (ICAN).

• Tuesday, Aug. 25, 9:00 pm (Eastern) / 6:00 pm (Pacific)
• $20 registration fee benefits ICAN
• Click here for additional details or to register

National Guide To A Healthy Birth

The 2009-2010 edition of Choices in Childbirth's National Guide to a Healthy Birth is now available.  A woman's choice of care provider for her pregnancy and birth is the single most important decision she can make to determine the type of birth experience she will have. The guide was created to help expectant women and families learn about their rights and options. Choices in Childbirth also publishes the New York Guide to a Healthy Birth and the Philadelphia Guide to a Healthy Birth.