With so many changes in healthcare and reimbursements to hospitals, looking for areas to cut can be tempting, but cuts to prenatal education are not the answer. In fact, in many cases, increasing Lamaze classes could be the answer.
The reasons why are simple. Payments are switching to value based purchasing metrics that reward high quality and patient satisfaction.
(Side note: As I started writing this I realized the evidence supporting Lamaze programs to improve quality and patient satisfaction is extensive. This was intended as a elevator speech sized article. Additional information on CMQCC and Lamaze can be found throughout the internet and there is an exceptional well written article in Lamaze’s The Journal of Perinatal Education, Volume 25, Number 4 entitled The Role of the Childbirth Educator in Supporting Vaginal Birth and Reducing Primary Cesareans; Highlights From the California Maternal Quality Care Collaborative Toolkit which will become available later in 2017 to the public at large.)
When we look more closely at the obstetric quality metrics that are impacting reimbursements, the first ones we notice are early elective inductions (<39 weeks gestation) and NTSV cesareans (cesareans for 1st time mothers with full term pregnancies and there is one baby with its head down).
In looking at the elimination of elective inductions prior to 39 weeks gestation, Lamaze’s Healthy Birth Practice #1 directly addresses this. In Lamaze classes, families are taught to Let Labor Begin on its Own. When labor is left to begin on its own, unless there is a medical indication for induction, hospitals are not penalized and everyone wins!
The reduction of NTSV cesareans are a little trickier. The California Maternal Quality Care Collaborative (CMQCC) has identified “key strategies for improving the Culture of Care, Awareness, and Education for Cesarean Reduction” and “key strategies for supporting intended vaginal birth” in their Toolkit to Support Vaginal Birth and Reduce Primary Cesareans (additional information here).
The first step in improving culture, awareness, and education looks directly at ensuring hospitals are providing evidence based childbirth education and removing barriers to childbirth education. The second step aims to focus on shared decision making and improve patient engagement. Both of these topics are included within the framework of all Lamaze childbirth classes.
In addressing strategies for supporting vaginal birth, steps include Step 1: Safely Reducing Routine Interventions (Healthy Birth Practice #4: Avoid Interventions that are not Medically Necessary), Step 4: Encourage the Use of Doulas (Healthy Birth Practice #3: Bring a Loved One, Friend or Doula for Continuous Support), and topics including utilizing comfort measure in early labor (Step 2), assessing pain and coping (Step 3), and utilizing intermittent EFM for low risk women (Step 6).
The hospitals who have implemented the steps within the CMQCC Toolkit have had many successes. Other organizations such as the Perinatal Quality Collaborative of North Carolina have had similar successes with their elimination of early elective inductions (more information here).
Stay tuned for Part 2, which will look at improving patient satisfaction through childbirth classes!