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Monday, March 19, 2012

Day 2: midwives as primary maternity care providers and inter-professional collaborative care

yesterday was intense. it was a long day and we had powerful discussions, the day culminating in the language of racism that exists in "white neo-midwifery".

i'll talk about this concept later as it is a big topic. one that is distinct from what i see as the intention of this conference. but one that is important in order to address the disparity in maternal and neonatal mortality rates in the united states.

a discussion that leads to more questions than perhaps answers. 


i attended two break away sessions yesterday.
take away message from both:

"the right care at the right time in the right place by the right people"

the question is - what does this look like and how do we get there?

in the two sessions, the first on midwives as primary maternity care providers, the second, collaborative care. 

Amy Romano discussed what a primary maternity care provider is and the concept of a maternity care home. These concepts are the outcomes of the 2020 Visioning and the Blueprint for Action.

some interesting distinctions that she made, which we can see happening in other countries, is the difference between midwifery care and midwife-led care. it is this concept that midwives need not necessarily be limited to low-risk women, but that midwives work with women, in a collaborative relationship with other healthcare provider to meet the individual needs of pregnant women. the midwife essentially coordinates a woman's care. 

this can work in conjunction with the concept of a maternity care home (which i discovered was not necessarily a discrete physical place - though it could be). 

Elements and features of maternity care home
-        primary maternity care providers assigned to each women
-        individualized care planning guided by
o      standardized risk screening
o      evidence-based guidelines
-        linkages with community resources
o      behavioural health services
o      mental health services
o      parenting services
-        preventative care
-        access to self-care information, reseources, and tools
-        accessto a higher level of care, as needed
-        shared decision making and clinical decision support
-        coordination of care
-        performance measurement and reporting, continuous quality imporovemnt
-        new payment models, eg. bundled payment, pay for performance (including “patient experince”)
-        community outreach to foster access to care
-        newborn care and breastfeeding support/promotion

the second part of implementing a system like this is by facilitating effective inter-professional collaborative care.

this is huge. 

Debbie Jessup talked about the MOM's for the 21st century act - HR2141 (122th)/HR5807 (111th), a large component of which involved the development of a core curriculum that is essential to providing high quality maternity care. one with a public health focus, incorporated cultural sensitivities, supports physiologic birth, and includes an interdisciplinary curriculum. 

emerging from the homebirth summit, statement six addresses the idea of interdisciplinary education. 

"effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settingsto achieve this, we believe that all health profession students and practitioner who are involved in maternity and newborn care must learn about each others disciplines and about maternity can health care in all settings."

Practical application of inter-professional education (IPE) in maternity care
-  focus on expanded understanding of roles, responsibilities, skills and training or maternity care providers
-    focus on expanded understanding and appreciation for varied birth settings
-    focus on promoting more integrated approaches to supporting women across all birth settings both in selecting sites for care and in movine from one care setting to another as needed/desired

Lisa Kane Low, CNM involved in the interdisciplinary education workgroup made an important argument that the cross training can and should begin between CPM's and CNM's. that we should be welcoming each other into our practices and spaces. learning from each other, gaining knowledge from each others expertise. 


so were does this leave us?

Day 3 - today we focus on where we want to go.

i have a lot more to say about the discussions from yesterday, and this is where i want to focus my attention. what i see as important in addressing the maternity care disparity in this country. 

we will see what emerges. 

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