Expecting Something Better:
A Conference to Optimize Maternal Health Care
May 18th and 19th, 2005
Westin Grand Hotel
On May 18 and 19, 2005, the Jacobs Institute of Women's Health held "Expecting Something Better: A Conference to Optimize Maternal Health Care." This working meeting successfully formulated the basis for recommendations to improve maternal health care in four main areas: the health of girls and women beyond pregnancy, disparities during labor and delivery, economic and psychosocial disparities, morbidity and mortality, and prenatal care. (Click on links in this document to view conference slides. The slides are the intellectual property of their authors).
After the presentation of commissioned papers on each of the four topics, participants attended breakout sessions to discuss each subject and develop recommendations to improve maternal health care.
The following are a summary of several of the breakout sessions' conclusions:
Achieving Safe motherhood: the Health of Women and Girls Beyond Pregnancy
- Increase interdisciplinary training and practice among primary care physicians, and specialized practitioners as well as midwives, health educators and other allied health professionals
- Reevaluate of school health guidelines from the perspective of safe motherhood to increase reproductive health knowledge among girls and boys
- Use performance measures as incentives to adopt evidence-based best practices
- Increase the perceived value of preventive care among consumers by improving health literacy and by identifying champions in sectors such as media and industry with a vested interest in spearheading programs promoting pregnancy in the context of a women's lifespan
Disparities in Maternal Health and Health Care
The group outlined action steps:
- Support the generation of evidence that will work to reduce disparities
- Encourage maternal health disparities impact assessment across social, housing, environmental and family policies
- Develop reliable, valid and consistent data collection instruments and measures to better understand and evaluate disparities
- Create a public campaign to raise awareness of the existence and impact of disparities
Maternal Morbidity and Mortality
- Standardize definitions of morbidity at the federal level
- Increase federal funding for state mandates of PRAMS (http://www.cdc.gov/reproductivehealth/PRAMS/index.htm) and maternal mortality review)
- Improve population-based surveillance of maternal morbidity and mortality with linkages to vital records, hospital discharge, ambulatory care and PRAMS data
- Extend of post-partum Medicaid benefits to one year
The Content of Prenatal Care
The group emphasized the need for:
- Periodically review and update recommendations for the content of prenatal care.
- Initiate a systems approach to facilitate the implementation of recommendations in a variety of settings
- Prenatal care to be evidence-based
- Greater emphasis on prenatal care during the intrapartum period.
- Implement evidence-based and culturally sensitive prenatal education program tailored to the need of individual patients
The conference also featured two keynote speakers: Gwyneth Lewis, MD, MSc, MRCGP, FFPHM, and Henci Goer.
Dr. Lewis, Principal Medical Officer for the Women's Health Department of the National Health Service in the United Kingdom, spoke about the UK's Confidential Enquiries into Maternal Deaths, detailing statistical trends and demonstrating the UK's work to understand the potential causes for and ways to reduce maternal mortality.
Henci Goer, author of The Thinking Women's Guide to a Better Birth, , discussed the Mother Friendly Model of childbirth, which posits that routine medical interventions during delivery are unnecessary in most healthy women and may, in fact, worsen pregnancy outcomes. She contends that this model has not been implemented due to the cultural predominance of a medical model of care and economic barriers.
New Research Findings and Preliminary Data
Two conference participants presented original and ongoing research in the field of maternal health. Carol S. Weisman, PhD presented data from the CePAWHS Project (Central Pennsylvania Women's Health Study) at Penn State University. This project aims to reduce disparities in adverse pregnancy outcomes (preterm birth and low birth weight) in predominantly rural central Pennsylvania, by improving women's preconceptional health. Sanders Korenman, PhD, examining data from Washington, DC found that infant and maternal health improved in Washington's African American population due to reduced prenatal smoking or associated behaviors, not a reduction in teen or out-of-wedlock childbearing.
The Jacobs Institute will publish the four commissioned papers in a special theme issue of our journal, Women's Health Issues. And papers resulting from a call for papers on maternal health care.
Jacobs will also post a detailed description of the conference and recommendations on this website in summer 2006.
This event was supported by an unrestricted educational grant from CIGNA HealthCare and conference grants from AHRQ and CDC.