Faculty Member Studies Quality of Care for Mothers

Series of journal articles provides review of literature on maternity services

Mayri Sagady Leslie, CNM, MSN (Frontier, CNEP Class 11) an Instructor, at the Nurse-Midwifery Program, School of Nursing and Health Studies at Georgetown University has published new research.

Washington, D.C.—Eleven years ago, the national Coalition for Improving Maternity Services (CIMS) released a list of 10 steps to improve care for new mothers during pregnancy and childbirth.

New research by a faculty member at the School of Nursing & Health Studies at Georgetown University Medical Center indicates that those 10 steps—described by CIMS in the Mother-Friendly Childbirth Initiative—do work.

Mayri Sagady Leslie, MSN, a certified nurse midwife in the school’s Department of Nursing, is among a team of national experts and CIMS members who has published its findings in the winter 2007 supplement to The Journal of Perinatal Education, a peer-reviewed publication of Lamaze International.

The group of researchers systematically reviewed 15 years of scientific studies that applied to each of the 10 CIMS steps. Sagady Leslie, along with several colleagues, specifically reviewed published literature that involved steps one, six, and seven. The summary of work as published is called, “The Evidence Basis for the Ten Steps of Mother-Friendly Care.”

Those steps say that mother-friendly care: (1) offers all birthing mothers unrestricted access to birth companions, labor support, and professional midwifery care, (6) does not routinely employ practices, procedures unsupported by scientific evidence, and (7) educates staff in non-drug methods of pain relief and does not promote use of analgesic or anesthetic drugs not specifically required to correct a complication. In addition, Sagady Leslie contributed to the appendix, “Birth Can Safely Take Place at Home and in Birthing Centers.”

Sagady Leslie pointed out that in 2005 the national cesarean rate for the United States reached a record high of 30.2 percent, while more than 20 percent of all labors are induced.

“I believe one reason for the increase in the use of technology for birth is that mothers are not getting the whole story,” she said. “Our publication will give mothers and their care providers new and important information they can use in making choices for their birth.”

CIMS is a collaborative effort of numerous individuals and more than 100 organizations representing over 100,000 members. The organization’s mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.

The release of the series of articles coincides with the 2007 CIMS Mother-Friendly Childbirth Forum and Annual Meeting, which is taking place from March 7-11, in Atlanta. Sagady Leslie will present at the five-day conference, which is titled, “Turning the Tide: Making Mother-Friendly Childbirth a Reality.”

Care Supporting Normal Birth is Best for Mothers and Babies: Acrobat_IconDownload this press release as an Adobe PDF document..

Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women, and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm. The Coalition for Improving Maternity Services (CIMS) Expert Work Group study entitled, Evidence Basis for the Ten Steps to Mother-Friendly Care, reviewed the evidence in support of each of the Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly Hospitals, Birth Centers, and Home Birth Services. Research findings include:

Ponte Vedra Beach, FL (PRWEB) March 1, 2007 — Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women, and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm.

The Coalition for Improving Maternity Services (CIMS) Expert Work Group study entitled, Evidence Basis for the Ten Steps to Mother-Friendly Care, reviewed the evidence in support of each of the Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly Hospitals, Birth Centers, and Home Birth Services. Research findings include:

• Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and more likely to end up needing forceps, vacuum extraction and a cesarean surgery.

• Inductions add to the risk of poor outcomes for the health of the baby. Artificially induced labors increase the rate of fetal distress and a serious complication of labor called shoulder dystocia (when the baby’s shoulders have difficulty passing through the mother’s pelvic bones). Elective induction babies are also more likely to need phototherapy to treat jaundice after birth, and are at higher risk for breathing difficulties and admission to neonatal intensive care.

• Use of electronic fetal monitors is over 85% on low-risk women. They fail to reduce the number of perinatal deaths, the incidence of cerebral palsy or the number of admissions to the neonatal intensive care unit. Continuous fetal monitoring puts women at increased risk for an instrumental delivery, cesarean section and infection.

• Overall 1 in 3 US women give birth by cesarean surgery. The majority of the operations are repeat procedures with no medical indication.

• When compared to women who have a vaginal birth, cesareans put women at risk for infections, hemorrhage requiring transfusion, surgical injuries, and complications from anesthesia, chronic pain, adhesions, hysterectomy, pulmonary embolism, placental problems with future pregnancies, and death. Babies born by cesarean are more likely to suffer from surgical lacerations, respiratory complications, and to require neonatal intensive care.

• There are more than 4.1 million US births a year with a cesarean rate over 30%. The health and economic impact of high tech birth is significant. In 2004, hospital costs for deliveries totaled over $30 billion dollars. The record high cesarean rate contradicts the national goals of Healthy People 2010 to reduce cesareans for first time mothers to 15% and increase VBAC (Vaginal Birth After Cesarean) rates to 63%.

The CIMS study found that harm is also caused by routine use of intravenous fluids (IVs), amniotomy (breaking the bag of waters), withholding food and water from women in labor, and episiotomy. CIMS recommends supporting normal birth for birthing women and limited use of many common and costly birth interventions.

The CIMS Evidence Basis for the Ten Steps to Mother-Friendly Care will be published as a supplement to the Winter Issue of The Journal of Perinatal Education. The results will be premiered at the CIMS Forum on March 8th at the DoubleTree Atlanta-Buckhead in Atlanta, Georgia.

Members of the CIMS Expert Work Group include: Henci Goer, BA, Project Director; Judith Lothian, RN, PhD, LCCE, FACCE, Project Coordinator; Mayri Sagady Leslie, CNM, MSN; Amy Romano, MSN, CNM; Katherine Shealey, MPH, IBCLC, RLC Sharon Storton, MA, CCHT, LMFT; Karen Salt, CEE, MA; Deborah Woolley, CNM, PhD, FACCE

The Coalition for Improving Maternity Services (CIMS), a United Nations recognized NGO, is a collaborative effort of numerous individuals, leading researchers, and more than 50 organizations representing over 90,000 members. Promoting a wellness model of maternity care that will improve birth outcomes and substantially reduce costs, CIMS developed the Mother-Friendly Childbirth Initiative in 1996. A consensus document that has been recognized as an important model for improving the healthcare and well being of children beginning at birth, the Mother-Friendly Childbirth Initiative has been translated into several languages and is gaining support around the world. For more information about CIMS and the Mother-Friendly Childbirth Initiative, visit www.motherfriendly.org.

To learn more about the research conducted by CIMS, visit the following websites:
http://gumc.georgetown.edu/update/
http://explore.georgetown.edu/news/?ID=22972
http://www.prweb.com/releases/2007/3/prweb508548.htm

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