US Birth Summit IV
History of Summits
In October 2011, a Home Birth Consensus Summit brought together stakeholders across the American maternity care landscape to address their shared responsibility for care of those who choose home birth. Organizers and delegates were a diverse, multidisciplinary group of leaders with a passion for quality and safety, and a commitment to work together to improve the safety and experience of care throughout the pregnancy, childbirth, postpartum, and newborn continuum. Discussions centered around integration of services for all childbearing families in the United States, within a cohesive maternity care system. Sandra Janoff, using the Future Search process, facilitated robust, respectful, and thoughtful dialogue, and delegates crafted a Common Ground Agenda of nine priority areas for action. In particular, delegates discussed the importance of building a maternal health care system that puts our most marginalized populations at the center, with the goal of improving health care for all.
Since the first Summit, nine multi-disciplinary Task Forces have worked together to identify and facilitate solutions to challenging issues in pregnancy and birth care. Progress in this area has required stakeholders with historically opposing views to collaborate throughout the development and implementation of innovative strategies for increasing access to high quality care for all communities, and across settings for birth. The areas of most significant concern are access to high quality care across communities in all regions of the country; inequities in health care delivery and outcomes; variations in experiences of respectful care; inequities in access to health professional education; evidence of implicit bias and institutional racism; the scarcity of person-centered quality measures; and challenges related to midwifery licensure and regulation.
Summit III in 2014 led to numerous data-driven quality improvement initiatives and the collaborative development of pragmatic tools to
Birth Summit IV
At Summit IV, we convened 150 leaders from 12 stakeholder perspectives: consumers, community health, service providers, consumer advocates, innovative models of care, health systems, health policy and law, research, payment reform, health professional educators, health administration, and quality and safety. Using a proven model for transdisciplinary engagement, delegates co-created an implementation strategy to ensure that evidence-based resources, and best practice models, become standard of care across the United States. Overall, our aim is risk reduction and improved access to high quality care across all communities.
MODELS, TOOLS, AND RESOURCES that delegates considered:
- Improved outcomes for mother and baby
Novel tools, evidence, and resources:
- The Access and Integration Maternity Care Mapping Study, and State Report Cards: national and state resources showing the effects of midwifery integration on outcomes
- Giving Voice to Mothers, Listening to Mothers-California : new information on how midwifery connects to outcomes
- Strong Start for Mothers and Newborns Evaluation **
- Lancet series on Scaling up Midwifery, improving Maternal Health, and reducing Cesarean Section: all agree that midwifery is the answer.
- Reduced costs
Novel tools, evidence, and resources:
- Strong Start for Mothers and Newborns Evaluation
- The Cost of Having a Baby in the United States
- Improved patient experience.
Novel tools, evidence, and resources:
- The Giving Voice to Mothers study results on the nature of disrespect, abuse, mistreatment or respect, resilience, and effective support in pregnancy and childbirth across communities
- Implicit Bias training modules endorsed by the BMMA and Young Women United leaders
- Overdue: Medicaid and Private Insurance Coverage of Doula Care
- ACOG’s Reduction of Peripartum Racial and Ethnic Disparities Maternal Safety Bundle.
- Continuous Support for Women During Childbirth
- Supporting physiology
Novel tools, evidence, and resources:
- Undisturbed Labour and Birth Index: accountability tool for institutions
- Birth Tools: online implementation guide
- Hormonal Physiology of Childbearing: (full report and many related resources for diverse stakeholders including policymakers, infographics, consumer booklet, etc.)
- The Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing
- ACNM Bundle: Intermittent Auscultation
- ACNM Bundle: Promoting Spontaneous Progress in Labor
- ACNM Bundle: Promoting Comfort in Labor
- ACOG and Society for Maternal Fetal Medicine: Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery
- New person-centered quality care measures
Novel tools, evidence, and resources:
- Mothers Autonomy in Decision Making (MADM)
- Mothers on Respect (MOR)
- The Mistreatment Index (MIST)
- Birth Place Research Quality Index
- Perceptions of Racism Scale
- Patient-reported outcome measures on patient satisfaction with hospitals
- Exemplars of Innovative Models for Service Delivery
- Commonsense Childbirth and the JJ Way
- Roots Community Birth Center
- Breath of My Heart
- Family Health and Birth Center, DC (FQHC)
- Changing Woman’s Initiative
- Health Connect One
- Oregon Intertribal Breastfeeding Coalition
- CBOs that Support Community Health
- New Voices for Reproductive Justice
- Sister Reach
- Sister Song
- Center for Black Womens Wellness
- Mama Sana
- Healthy Start Pittsburgh
- Health Professional Education renewal
- Brown University: Midwifery Faculty for Obstetric Residency
- Bastyr University: Implicit Bias Training Curricula and Scholarship programs to increase providers of color
- Black Women's Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities
- Tools That Support Effective Collaboration
- State Perinatal Quality Collaboratives
- Best Practice Collaboration Guidelines across Birth Settings,
- Dialogue and Decisions, a novel interprofessional online course for physicians, midwives, nurses, teaching skills in respectful communication, cultural safety and person-centered decision making
- Person-Centered Decision Making Tool: a clear step by step guide for professionals working together to keep the focus on the service user’s context and priorities for care.
- New Risk Management Courses for care across birth places (see Southern Cross Insurance)
Now it is time to implement these novel resources across the US health system.
STAKEHOLDER AND DELEGATE NOMINATION PROCESS
The Future Search model for co-creation requires narrowing the focus and keeping the eye on the goals of the meeting when identifying stakeholder groups, and when nominating delegates. In this case the goals were to “address our shared responsibility to equity, safety, and respect”, and to upscale and expand access to emerging tools, models, and resources towards this aim. Each delegate should have “authority, expertise, resource, need, and/or information” on this topic, and the whole system should be in the room bringing a diversity of perspectives. Our Steering, Planning, and expert consultants identified the stakeholder groupings, and how each would contribute to a dialogue on implementation. The delegate invitee list was then refined through multiple rounds of consultations with the Steering Council and Planning Committee members who represent all stakeholder groups.
To encourage participation of community members and key change agents, key organizations (such as ACOG, BMMA, NAABB, NACPM, Sister Song, YWU, AWHONN, MANA, ACNM, IMI, NPWF, etc.) were invited to nominate delegates, recruit sponsors, and if possible, cover the cost of registration, accommodation, and travel of at least one consumer representative as well as their own delegate. Delegate participation was by invitation only, but at this Summit offered video-conferencing registration for consumers, partners, and clinicians.
EXPERT FACILITATION
Mode of delivery, model of care, place of birth, and equity in access to high quality care are often contentious subjects in the United States, and are current topics of scrutiny in the public domain. Following a wide search and nominations by the Steering Council, we vetted several expert facilitators and settled on a 2-person team of Senior Facilitators who are both well versed in Future Search design and have fluency with the domains of maternity care, equity, disparities, and physiologic birth care. The Future Search structured meeting process has the flexibility to allow intense discussion and debate, elevating the voices of consumers, while prioritizing commitments for implementation of novel initiatives, accountability measures, curricula, etc., by the close of the Summit. Moreover, Future Search meetings are based in an authentic co-creation model, which will enable broad buy-in, endorsement, and external credibility.
GRANTS, FOUNDATIONS, DONORS
To achieve the goals outlined in this prospectus, we are seeking donors and funders to support the convening of US Birth Summit IV. Sponsor packages available here.