Mary Lou Moore, PhD, nurse, and faculty member at Wake Forest School of Medicine, spoke about The Perinatal Care System in the 21st Century: Induction, Cesarean Birth and Late Preterm Birth, sponsored by the March of Dimes. Her presentation covered recent research showing that elective deliveries (induction and cesarean) should not be performed before 39 weeks. In addition, it's advisable not to induce at that point unless the Bishop score is 8+ for primips and 6+ for multips.
These "early term" births at 37 & 38 weeks have increased rates of complications for baby and mother. (We're not talking about mothers who go into labor spontaneously at these weeks.) It's not just an issue of fetal lung maturity, but a wide range of other physiological changes the term baby undergoes before labor beings. We only understand a small number of these complex mechanisms. We know, for example, that a baby's brain grows rapidly between 34-40 weeks; the frontal lobes are especially vulnerable to elective deliveries as they are the last to fully develop.
She then outlined several hospitals around the country that have implemented these new guidelines for elective deliveries:
- Starting in 2004, Magee Women's Hospital in Pittsburgh implemented a policy of no elective deliveries before 39 weeks. Between 2004-2007, their rate of elective induction (EI) went down 30% and the overall induction rate fell 33%. The cesarean rate for primips dropped 60% over those years from 34.5% to 13.8%.
- The Perinatal Quality Collaborative of North Carolina (PQCNC, pronounced "picnic") decided to stop elective deliveries before 39 weeks in 38 hospitals across the state. This led to a 12% reduction in elective deliveries, a fall in newborn complications and NICU admissions.
- The Ohio Perinatal Quality Collaborative (OPQC) has had similar outcomes.
Zari joined me for the final keynote speaker: Linda Smith, author of Impact of Birthing Practices on Breastfeeding. I missed about the first third of the presentation because Suzanne Arms pulled me aside and said, "I hear I need to meet you!" (How cool is that??!) We talked about what we're both working on and her future plans in trying to gather people from all walks of life and all parts of the world to envision a new global strategy for improving all things related to birth and breastfeeding.
Back to Linda Smith's presentation...I entered right before she showed an excerpt from a fantastic new breastfeeding DVD Skin to Skin in the First Hour After Birth: Practical Advice for Staff after Vaginal and Cesarean Birth. Here's an excerpt for you to watch:
I really hope I can obtain a copy of this DVD to review. It was produced for health care providers and teaches immediate, uninterrupted skin-to-skin for both vaginal and cesarean births. It also shows nine stages that newborns go through in the first hour after birth when they are placed skin-to-skin immediately after the birth. Really amazing stuff!
Linda emphasized that 30+ years of birth advocacy have done little to change childbearing practices. However, using the breastfeeding angle to change birth practices has been remarkably successful. In fact, the new Baby-Friendly curriculum includes a Mother-Friendly module as part of step 3: "Inform all pregnant women about the benefits and management of breastfeeding." I wasn't able to write down the details, since I was keeping Zari occupied, but you can email Linda if you'd like more information about this. She urged us to keep an eye out for the Surgeon General's breastfeeding statement that will be coming out in the next few months. There's a lot of support behind breastfeeding--witness Michelle Obama's many supportive statements about breastfeeding--especially because it is associated with lower obesity rates. In sum, if you want to change birthing practices, use the breastfeeding angle. There's a lot of money, government support, momentum behind breastfeeding, so run with that to improve health care for both mothers and babies!