Ginger Breedlove, PhD, CNM, FACNM, FAAN’s Post

Virginia, like much of the country has a growing practitioner shortage for reproductive health care, especially in our rural regions. Medicaid reimbursement rates for OBs and CNMs in the Commonwealth are significantly below the actual costs of providing pregnancy care, creating financial strain and reducing access to services. Certified Professional Midwives (CPMs) receive just 85% of this already inadequate rate for delivering the same care, further limiting their sustainability. Compounding this, Certified Midwives (CMs) are not recognized as Medicaid providers at all, leaving them without any reimbursement for their services, despite being highly trained to provide comprehensive maternity care. These disparities in payment threaten the viability of midwifery care and undermine equitable access to maternal health services in Virginia.

Extract-‘National disgrace’: black mothers in England twice as likely to have NHS birth investigated The births of babies to black mothers are almost twice as likely to be investigated for potential NHS safety failings, in a shocking disparity that has been labelled a “national disgrace”. More than 2,300 investigations were completed by England’s maternity safety watchdog between 2020 and 2023 into cases including the tragic deaths of babies before, during and soon after birth, and the deaths of expectant or new mothers. For every 1,000 deliveries by black women, there were 2.3 investigations, compared with 1.3 for white women, Guardian research found. The head of the Royal College of Midwives (RCM) said the issue was “purely down to institutional racism”. The Labour government has pledged to prioritise improvements to maternity care, including tackling the stark racial disparities. Maternity and Newborn Safety Investigations (MNSI), which is part of the Care Quality Commission (CQC), is a safety programme that examines serious instances of maternal or neonatal death, stillbirths and babies born with severe brain injuries across the NHS in England. All NHS trusts are required to tell the MNSI about certain patient safety incidents in order for an independent investigation to be carried out. The monitoring body is part of a national strategy to improve maternity safety… Freedom of information requests and research by the Guardian shows black women are almost twice as likely to be subject to a maternity investigation than their white counterparts. Black mothers are also three times more likely to be subject to an investigation regarding an instance of maternal death and just over twice as likely in cases of intrapartum stillbirths, when the baby dies after labour begins. The higher rate of investigations is a reflection of black women’s increased likelihood of experiencing maternal death, stillbirths and having babies born with severe brain injuries… The idea that the colour of your skin when you give birth should have such a huge impact, and potentially a fatal impact, on your outcomes is a national disgrace. I’m pleased that the current Labour government, in one of their manifesto commitments, [will] set a target to reduce the disparities when it comes to black maternal health, and I’m hoping to see detail of that soon.” Gill Walton, the chief executive of the RCM, said the issue was “purely down to institutional racism”. “It should not be the case in the 21st century a baby’s or mothers’ chance of survival is determined by the colour of their skin or where they are born,” she said. “But, sadly, that is the experience of too many families. It is not enough to express our shock and sorrow: we must act… https://lnkd.in/ey7HfXN8

Beyond disgraceful how much evidence do they need to stop this madness. Invest in Midwifery recruit & train. Positively stop the staff shortages. Ensure better working conditions & concentrate on retaining the highly skilled who are leaving in droves.

NIHR New Maternity Early Warning Score to be implemented in the NHS   Researchers funded by the NIHR have developed a new, standardised tool to help identify and respond to signs of deterioration in the health of pregnant women.   The new “maternity early warning score” is based on patient data and is set to be rolled out across the country.    Maternity Early Warning Scores Maternity Early Warning Scores (MEWS) are widely used throughout hospitals in the UK to highlight when additional care is needed to protect the health of the expectant mother and baby. Their implementation varies widely across the country, and the majority of MEWS have been developed by clinical consensus.   For this study, researchers funded by the NIHR’s Oxford Biomedical Research Centre identified the need to create a standardised MEWS that could be rolled out nationally.   The study The Pregnancy Physiology Pattern Prediction (4P) prospective UK cohort study collected data from 1,041 women during their pregnancies including: ·        blood pressure ·        heart rate  ·        respiratory rate ·        temperature ·        oxygen levels   The researchers used statistics to determine appropriate thresholds for each vital sign. These thresholds were then used to assign numerical scores, with higher scores indicating more concerning vital sign measurements.   The clinical response to higher scores was developed by 30 midwives, doctors and other experts. The researchers used a consensus exercise which allowed experts to reconsider their opinions based on the anonymised opinions of others. This ensures that the new national MEWS not only identifies potential problems, but also provides clear guidance on the appropriate escalation of care.” https://lnkd.in/eqh-h_t4

Three south west trusts to launch BadgerNet maternity system - Digital Health #BadgerNetMaternitySystemLaunch Three south west trusts are set to launch the BadgerNet maternity system, a digital platform designed to streamline maternity care processes and improve patient outcomes. The system will be implemented at three trusts in the south west region, with the goal of enhancing communication, data sharing, and overall efficiency in maternity care. #DigitalHealthTechnologyIntegration #BenefitsOfBadgerNetMaternitySystem The BadgerNet maternity system offers a range of benefits for healthcare providers and patients alike. These include improved access to patient information, enhanced communication between healthcare teams, and better coordination of care throughout the maternity journey. The system also enables real-time monitoring of patient progress and facilitates seamless data sharing between different healthcare settings. #PatientCare ai.mediformatica.com #trust #hospital #hospitals #badgernet #health #maternity #nhsfoundationtrust #systemc #acce #digital #pregnancy #acutehospitalalliance #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3zXdOWz)

It's a barely kept secret that almost no one wants to give birth in Tuscaloosa. In the city there are two hospitals, both part of the same system. But a large portion of the population chooses to travel more than 45 minutes out of town to give birth in one of the roughly dozen hospitals and other options located in Birmingham. The practice is so wide-spread that a handful of the OBs in the city are actually just Birmingham physicians who come once or twice a week to do prenatal care so their patients can travel less for those appointments (that includes the only high risk pregnancy specialist in the area). I won't go into the myriad of reasons a person would prefer to travel almost an hour while in labor rather than go to the hospital 10 minutes away. If you've been reading my feed for a while I'm sure you can make some guesses. What I can tell you is that those are essentially the two options - and that for many low-resourced patients, only one option is possible. But what if it wasn't? When Dr. Stephanie Mitchell of Birth Sanctuary Gainesville came in today to meet staff and tour the clinic the solution was obvious: What if we turned our currently unused recovery room into a birthing suite? The space is ideal. It's tucked into the back, with its own private bathroom and a door directly to the outside for families to come and go without heading through the clinic itself. Plus it is about 5 minutes from the hospital should any issue come up. It does need some major cosmetic help. The wallpaper is from the 1980s and the flooring has seen much better days. It needs a new door (or any door) and all of the furnishings that would make birth comfortable. A new overhead light needs to be installed to allow dimming. We need a bed, a space for a birthing pool (and, actually, a birthing pool, too), and so many other things. Still, it can definitely be done, and without any actual breaking walls, adding plumbing or the rest (although that would be nice to do someday, too). And even better it could be done fairly quickly, letting us then start the licensing process in early fall. And with our wrap around crew of amazing staff, doulas and consultants we could really be a place for those who meet the criteria and provide a true, local option for patients who worry that the hospital could be a physically or emotionally harmful experience. Yall know me well enough by now to know that when I feel like there is a need to be met I will jump straight into it and assume I can find a way somehow to get it covered - usually by going to the supporters who believe birth equity in Alabama is something that deserves support. So.... This is our campaign. Anything that isn't used for set up will be used to subsidize those who are uninsured so they can have the same birth experience that those with money can access. The work starts next week, because funded or not, it's just too important to wait. https://lnkd.in/eKdQwCqi

Advocacy and Activism Did you know evidence shows that 27% of low-risk pregnancies would have surgical births if they delivered in a hospital, compared to 6% when a birth center is an option? And when planning an assisted homebirth, it drops to 5%! Let's reduce the numbers of first-time c-sections that could have been avoided. Many low-risk pregnancies can SAFELY be birthed OUTSIDE of hospital settings like birth centers or planned homebirths. Many families are unaware of their options, don't have them or are provided fear mongering whenever there's discussion of birth out of hospital settings. "But what if something happens?" That something happening is more likely to occur in a hospital where birth is heavily medicalized and where pregnancy is seen as an illness and birth requires "treatment". When a pregnancy is healthy, considered low-risk for any current or potential adverse pregnancy conditions, the best place for that birth is in a loving, nurturing and unrushed environment. Unfortunately, that's not in many hospitals across the US where the focus is on the treatment of sick or injured patients. So, by default, birth is seen as something to manage as well. Last week, I was invited to provide testimony on this very subject via a committee on Aging and Human Services lead by Assemblywoman Speight. There's a lot of education that needs to happen in the community and assembly halls in order to move birth forward as a nation. The midwifery model of care needs to be adopted nationwide to reduce maternal and infant mortality rates AND improve birth experiences free of trauma and scare tactics. Insurance companies need to stop viewing birth centers and midwifery care as "out of network" to provide more access and coverage to families who choose natural birth settings. There also needs to be parity in reimbursements to birth centers and midwives so that they can remain sustainable in the communities that need them most. Lastly, states need to fund freestanding birth centers to ensure longevity and so they can provide competitive salaries to midwives and staff. When birth is respected, left to biology and honored fewer families will know birth trauma. Of course, there will always be a need for medical interventions when negative variations of birth or complications arise. Let's not overuse them just because they exist! The cascade of interventions starting with the IV and ending with cesarean as part of ROUTINE protocols isn't doing birth any favors. Changing the culture of birth happens one testimony at a time. #AssemblywomanShaniqueSpeight #ThebirthcenterofNJ #naturalbirth #unmedicatedbirth #lowrisk #lowinterventionbirth #savemoms #savebabies #reducefirsttimesurgicalbirths #waitforlabor #homebirth #birthcenterbirth #honorlabor #sacredbirth #nurture #support #birthpreferences #birthoptions #iatrogenic

My sister-in-law is an OBGYN and often talks about how egregious it is that she's paid less than my brother (a urologist) per unit to do circumcisions. 37% of all doctors are women but somewhere between 50-60% of OBGYNs are women... so this means, once again, we are devaluing work that falls to women (and also to the women who are receiving OBGYN care). As this piece in TIME points out... "Because of the way billing codes are structured, pay for maternity care is often made in a lump sum meant to cover a woman's whole pregnancy, which doctors say significantly under-prices the care they give." Similarly, I get asked a lot why there aren't more in-network pelvic floor PTs. Based on our data at Origin, 80% of all pelvic floor PTs in the US are out-of-network. And there's a lot of reasons... but the #1 reason is that much like maternity and OBGYN care, pelvic PT is under-reimbursed and insurance companies have not caught up to account for the complexity/speciality of the care. For example, did you know that there's no CPT codes that are specific for pelvic floor PT? This means our clinical team has to bill based on orthopedic codes for which the average visit is 15-20 min, whereas our clinicians spend 45 min, 1:1 with every patient. If we want to see more pelvic floor PTs opening and fewer maternity centers closing we need reimbursement for the time and care we're providing to catch up. #womenshealth #pelvichealth #maternitycare #pelvicfloor

Gov. JB Pritzker signed a new law Monday that advocates hope will close maternal health equity gaps by expanding coverage for services. [Health News Illinois] The law tasks insurers with covering all pregnancy, postpartum and newborn care provided by perinatal doulas and licensed certified professional midwives.  Coverage includes home births and home visits. Home visits by lactation consultants would also be covered, as well as recommended products like breast pumps and feeding aids. Insurance policies will have to cover up to $8,000 of home visits by a perinatal doula for each pregnancy and postpartum period. Medicaid will also cover certified professional midwife services. Pritzker said during a bill signing in Chicago that the law follows through on his promise earlier this spring to address disparities in maternal health, specifically among Black women. “Black women are three times more likely than white women to die from medical complications during pregnancy and childbirth,” he said, citing a Department of Public Health report released last year. “That is appalling, it's unacceptable and we're not going to let that happen anymore in the state of Illinois.” Sen. Lakesia Collins, a Democrat from Chicago who sponsored the legislation this spring, said the disparities can no longer be ignored. “This law was not just about healthcare — it's about justice, equality and the right of every mother and child to have access to the safest and most effective care,” she said. Stakeholders noted the law is part of a larger effort underway in Illinois to improve maternal health outcomes.  The current state budget includes $15 million to support home visiting expansion, $4 million to support IDPH’s assessment of the state’s maternal mortality rate and the creation of an action plan to serve affected communities, $5 million to expand the Department of Human Services’ home visitor program, and $1 million to fund a pilot program at DHS to provide diapers. It also includes capital grant funding to support birth centers trying to open in underserved areas as well as facilities that have seen an influx of patients in the two years since the Supreme Court’s Dobbs decision. “There's more work to do, but this is an enormously important first and big step,” Pritzker said.   #maternalhealth #medicine #dental #publichealth #populationhealth #communityhealth

"Black maternal death rates have been steadily rising in the United States for decades, Black women in Miami-Dade County today are three times more likely to die from childbirth and related complications than White women. The Centers for Disease Control and Prevention estimates that four out of five of these deaths are preventable. The history of structural and institutional racism which has resulted in inadequate access to care, maternity care deserts, lack of health insurance, and implicit bias, are at the root of the Black maternal health crisis. Think about that. Why is the disparity so great? And why do we allow it to continue when we have a blueprint for better perinatal outcomes? It is physiologic birth and midwifery, which is the standard of care in every single country that is doing well in the areas of maternal and infant health. Also, most of those countries have some version of universal healthcare to address the needs of uninsured pregnant people and a robust infrastructure to support care coordination and integration including postpartum care and family leave. The alarming statistics on Black death rates in the United States call for urgent action to address the health equity crisis that is pervasive throughout our nation." #BlackMaternalHealthWeek #maternalchildhealth #maternalhealth https://lnkd.in/eesYSJwe