By Cynthia Pellegrini, March of Dimes
It sounds like a rejected Hallmark card: “Sending you wishes for high quality maternal and child health care, today and every day.” But on Mother’s Day, it’s especially appropriate to talk about healthy women, healthy pregnancies, and healthy babies and children.
For many of us in the health policy field, it would have been easy to miss the slow but steady increase in attention paid to the quality of obstetrical and maternity care. Thanks to the efforts of the March of Dimes and other maternal and child health advocates, provisions related to the development of perinatal and pediatric quality measures were included in the Child Health Insurance Program Reauthorization Act of 2009 (CHIPRA), requiring the Agency for Healthcare Quality and Research to produce new measures on a specific timeframe. Those provisions served, in turn, as a model for many of the broader quality initiatives included in the Affordable Care Act in 2010. The National Quality Forum (NQF) has endorsed a growing list of perinatal measures over the past 3 years (currently over 30 for pregnancy and neonatal care), while the Joint Commission announced its Perinatal Care measures core set in late 2009 and began collecting that data in spring 2010.
Meanwhile, certain aspects of perinatal care were under additional scrutiny. In particular, concern arose about the practice of scheduling elective deliveries before 39 weeks of complete gestation as a growing body of research indicated the importance of the final weeks in utero and the increased risk of the need for Neonatal Intensive Care Unit (NICU) care for newborns delivered before 39 weeks. The March of Dimes identified this as a key actionable priority, developed and tested an extensive toolkit for hospitals to use in ending this practice, and urged its adoption through its network of chapters in every state. Other organizations took up the cause as well; a 39 week quality measure was endorsed by NQF and is one of the five measures in the Joint Commission’s Perinatal Care core set.
In many communities, the results have been dramatic. Some hospitals and systems that have implemented a “hard stop” on elective deliveries prior to 39 weeks have reported decreases of more than 20 percent in NICU days. The March of Dimes recently completed development of a service package for hospitals seeking to implement a hard stop policy but interested in more support. The service package includes access to a data portal that will provide real-time feedback, grand rounds, access to experts, and more. This package is being made available at no cost to 100 hospitals in 2012; the request for applications recently closed with far more than that number having been received.
In mid-2011, the March of Dimes opened conversations with the Association of State and Territorial Health Officials (ASTHO) about setting goals for President David Lakey’s presidential challenge around healthy infants. It was calculated that, by implementing a set of targeted interventions, states could expect to reduce their preterm birth rates by 8 percent. The target interventions are: a hard stop on elective deliveries before 39 weeks; access to the drug 17p to prevent preterm labor for women who have had a previous preterm birth; tobacco cessation for pregnant women; and changes in assisted reproductive technology to better manage the creation of high-order multiple births. In 2011, Dr. Lakey challenged his fellow health officers to adopt the goal of reducing preterm birth by 8 percent by 2014. And the response has been tremendous — as of this writing, thirty states’ health officers have publicly accepted the challenge and are moving forward to address it, with more still expected to join.
They say that nothing breeds success like success, and in this case the enthusiasm certainly continued to build. In February 2012, the U.S. Department of Health and Human Services (HHS) took a major step toward helping to ensure healthy pregnancies and healthy babies for all women with the launch of the Strong Start program. Strong Start has two distinct but interrelated components: first, an effort to reduce the scheduling of elective deliveries before 39 weeks of gestation for all women, and second, a $43 million grant program to test three promising approaches toward prenatal care for at-risk women on Medicaid. HHS and the American College of Obstetricians and Gynecologists added their support to March of Dimes consumer education materials to produce a set of co-branded products that would reinforce the messages of the 39 weeks component of Strong Start. States and other applicants have responded energetically to the Strong Start grants opportunity, forming coalitions of partners all dedicated to testing the models of group prenatal care, birthing centers, and maternity health homes. Applications for the grant program are due soon, with funding announcements expected in September.
All of these and many other important initiatives are combining to create to a critical mass in the movement to improve perinatal health care. It won’t happen overnight, and there’s obviously still much more to do. But we are making meaningful progress – for the past three consecutive years, the rate of premature birth has registered small but significant declines after rising for more than three decades. We can make a difference for healthier women, babies and families.
We’re on our way to providing quality perinatal care to all women. Happy Mother’s Day to all the moms out there – past, present, and future!