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Issue 2, May 1, 2015



The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

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This week’s collection of articles is brought to you by BabyLove. Are you in Minnesota near the Mall of America? Veronica Jacobsen and the whole team at BabyLove, an independent childbirth education center, have a lot to offer! Check out the class schedule and pass on the good word about BabyLove to pregnant friends in or around Eagan, MN.


CMQCC’s OB Hemorrhage Toolkit 2.0 is available for download. The Toolkit includes care guidelines (in checklist, flowchart or table chart formats) and a slide set for professional education in PDF format.

More than 2000 have been downloaded worldwide since March 24. Have you downloaded the toolkit for your hospital?



April was Cesarean Awareness Month and someone at Society for Maternal Fetal Medicine put a lot of time into creating a month-long social media campaign that ended up being a fantastic cheat sheet of recommendations for preventing a primary cesarean. See all of their tweets at the end of this article.


UCHealth aims to lower C-section rates



Women with epilepsy face tough choices over their medication

Review on how treatments for epilepsy in pregnancy may affect the unborn child, and the dilemma facing young women making decisions about their treatment. (Cochrane)



The battle for better maternity care shows the limits of the Amazon warehouse approach to medicine

“The issues around maternity care are a microcosm of the bigger battles in the NHS – centralisation, protocols and “efficiency savings” v making a space for common sense, professional judgement and personal relationships.”



Hospitals work to fast-track C-section’s

“Hospitals rework C-section policies to promote quicker bonding between mothers, babies”



Aid for consumers; Data helps health-care decisions


(Subscriber access only but I wrote it so I’m including it here anyway. PDF here.)


A Cluster-Randomized Trial to Reduce Cesarean Delivery Rates in Quebec

Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies.



Pediatricians Issue New Guidelines for Hospital Release of Newborns

The decision to allow a healthy newborn to go home is made after careful review by health providers, but there can be wide variation in the degree of an infant’s readiness to leave the hospital, and a number of factors need to be considered, according to the AAP.



Continuing to Help Low-Income Women Access Primary Care

“…ACOG has launched the nationwide advocacy initiative, All-in for Women’s Primary Care. Regardless of whether your state has expanded its Medicaid program under the Affordable Care Act, your state can raise Medicaid primary care rates to Medicare levels for ob-gyns.”



A very cool interactive infographic from IOM that accompanies the report titled “Vital Signs: Core Metrics for Health and Health Care Progress”



A Big Step Forward for Health Care Transparency in New Mexico

One major reform to come out of the 2015 legislative session was a law that will dramatically increase the transparency of hospital prices and quality data.

The new statute, which passed both the Senate and House unanimously and was signed by the Governor, updates the existing Health Information System Act to allow the Department of Health to release hospital-specific quality and cost information. Much of this data has been collected from hospitals for the last two decades, but the old law prohibited the Department of Health from releasing it in a way that identifies specific hospitals.



From the archives: Inés Ramírez Pérez and the Mythical Self-Cesarean (2009)


The oddball start-up that shows how ObamaCare has made a friendlier insurance market

“It’s got a user-friendly website that offers providers after you type in your symptoms, along with free 24/7 internet consultations with doctors. It lets you compare prices from different providers and refill prescriptions with one click. It’s even partnering with CVS to build care locations throughout the state, and it’s hiring nurses to offer in-home follow-up services, especially for new moms.”


“Before the health reform law, all the incentives encouraged insurers to exploit consumers rather than help them. Most people who weren’t on government-provided insurance got their private coverage through their employer. (And still do.) In that case, insurers have an incentive to make employers happy, but little reason to offer customers transparency or quality service.”



Future of health care: innovation and personalized medicine

A very perky article on the impact of the fee-for-value approach



Commonwealth Fund’s Health Policy quiz

I failed this. Really badly.



Canadians unaware about the full cost of health care



From the archives: Defending Ourselves against Defensive Medicine (2011)

Can Transparency Tools Further the ACA’s Goals of Reducing Costs?



What Hospital Websites of the Future Will Look Like

Leapfrog’s Leah Binder thinks that “[t]he hospital (and its website) of the 21st century will look very little like the ones we encounter today. And that will be a good thing for its customers—the patients.”



Hospitals Provide a Pulse in Struggling Rural Towns

Rural hospitals face huge challenges; nearly 50 of them have closed in the last four years, according to the North Carolina Rural Health Research Program. But the many successful hospitals, beyond providing an array of jobs from the bottom to the top of the economic ladder, also stimulate local spending and help attract new businesses that offer a stable of insured patients.




Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports

A Month of Cesarean Awareness Month Tweets from the Society for Maternal Fetal Medicine, 2015:

Results for #prevent1stcs


Apr 30

Thanks for all you do to keep #mothers and #babies safe!  #Prevent1stCS #CAM2015 is part of this! http://ow.ly/KUj64

Apr 29

Advise on short/long-term risks of the surgery for both woman and baby- in present and future #Prevent1stCS #CAM2015 http://ow.ly/KUj63

Apr 28

Intermittent auscultation acceptable in low-risk patients without #FHR abnormalities #Prevent1stCS #CAM2015 http://ow.ly/KUj61

Apr 27

Repeated #cesarean increases risk of #accreta- a major safety concern for mom and baby #Prevent1stCS http://ow.ly/KUj5z

Category II tracings don’t mean CS - they mean evaluation and continued surveillance are needed #Prevent1stCS #CAM2015

Apr 26

Unless indicated, avoid elective induction with bishops score <8. Ripen if you must induce #Prevent1stCS #CAM2015 http://ow.ly/KUj5B

Apr 25

1st cs may slightly decrease neonatal risk, difference through lifespan increasingly smaller #Prevent1stCS #CAM2015 http://ow.ly/KUj5Z

Apr 24

#cesarean does have a place in modern practice and can be lifesaving for some moms and babies #Prevent1stCS #CAM2015 http://ow.ly/KUj5A

Apr 24

1st cs only small risk maternal morbidity, difference increases throughout reproductive life #Prevent1stCS #CAM2015 http://ow.ly/KUj5Y

Apr 23

Repeated #cesarean increases risk of #accreta- a major safety concern for mom and baby #Prevent1stCS #CAM2015 http://ow.ly/KUj5z

Apr 23

Counsel appropriately that elective cs 1st increased risk major maternal morbidity 10% by 4th #Prevent1stCS #CAM2015 http://ow.ly/KUj5y

Apr 22

Encourage policy changes at your hospital within NICHD and SMFM guidelines to help #Prevent1stCS #CAM2015 http://ow.ly/KUj5X

Apr 20

Excessive weight gain increases cs! Help women keep weight gain in IOM recommendations to #Prevent1stCS #CAM2015 http://ow.ly/KUj5V

Apr 19

EFW late gestation imprecise, counsel, reserve cs >4500 grms diabetics >5000 grms non-diabetics #Prevent1stCS #CAM2015

Apr 18

Document fetal presentation at 36 weeks to allow discussion and attempt of external version #Prevent1stCS #CAM2015 http://ow.ly/KUj5U

Apr 17

When inducing, don’t call failure til latent phase >24 hrs and >12-18 hrs of oxytocin after AROM #Prevent1stCS #CAM2015

Apr 16

Don’t forget cervical riping! Riping reduces risk of #cesarean when inducing unfavorable cervix #Prevent1stCS #CAM2015

Apr 15

If there are no maternal/fetal indications- hold off on induction of labor until 41 weeks #Prevent1stCS #CAM2015 http://ow.ly/KUj5T

Apr 15

@WHO proposes Robson system for comparing #caesarean rates between facilities/countries/regions.http://ow.ly/LCyqg  @Lancet #Prevent1stCS

Apr 15

#Caesarean sections should only be performed when medically necessary says @WHO http://ow.ly/LCjFo  #Prevent1stCS

Apr 14

Category 2 tracing?  Consider scalp stim to assess fetal acid-base status as a safe alternative to #Prevent1stCS #CAM2015

Apr 13

#amnioinfusion for repetative variables may help #Prevent1stCS #CAM2015 http://ow.ly/KUj5S

Apr 12

Consider manual rotation for fetal malpresentation in #secondstage before #operativedelivery #Prevent1stCS #CAM2015 http://ow.ly/KUj5P

Apr 11

#Operative delivery by experienced and well-trained physicians is safe alternative to #Prevent1stCS #CAM2015 http://ow.ly/KUj5O

 Apr 10

Diagnosis of arrest 2nd stage is >2 hour muliparous and >3 hours nulliparous women #givewomantime #Prevent1stCS #CAM2015

Apr 9

There is no absolute maximum for the #secondstage, allow for variation with progression #Prevent1stCS #CAM2015 http://ow.ly/KUj5M

Apr 8

Active phase arrest should be reserved for >6cm for >4 hours with adequate uterine activity #Prevent1stCS #CAM2015 http://ow.ly/KUj5L

Apr 7

Protracted latent phase >20 hrs #nulliparous >14 hrs #multiparous not a indication for cs #Prevent1stCS #CAM2015 http://ow.ly/KUj5J

 Apr 6

Options for latent phase include time, #AROM or #oxytocin to achieve active labor #Prevent1stCS #CAM2015 http://ow.ly/KUj5I

Apr 5

6 cm is the new 4! Don’t call active labor protraction or arrest til adequate time elapsed! #Prevent1stCS #CAM2015 http://ow.ly/KUj5H

Apr 4

Each cs increases risk in next - #Prevent1stCS can improve outcomes for a lifetime  #CAM2015 http://ow.ly/KUj5F

Apr 3

10 fold variation #cs across US from 7.1% to 69.9%- how does your hospital rate? #Prevent1stCS #CAM2015 http://ow.ly/KUj5E

Apr 2

Severe maternal morbidies increase risk #cs 3 fold- prevention and early treatment can help #Prevent1stCS #CAM2015 http://ow.ly/KUj5x

Apr 1

Experts agree #cesareanrate too high in US @mySMFM committed to lowering safely follow for tips #Prevent1stCS #CAM2015


Issue 1, April 24, 2015


The intersection of maternity care, data transparency, health care costs and patient safety in a weekly curated list of articles of interest.

Tne Unnecesarean in your inbox? Yes, please! Enter your email address:


Want everyone to see your product or service here? Find out how!


The Connection Between Evidence-Based Medicine and Shared Decision Making

Journal of the American Medical Association




National Healthcare Quality & Disparities Report 2014

Agency for Healthcare Research and Quality




Oregon Doctors Try To Reduce Number Of C-Section Births

Oregon Public Broadcasting




Why are C-section rates still so high?

San Diego Union-Tribune




Beyond SGR: Aligning The Peanut Butter Of Payment Reform With The Jelly Of Consumer Engagement

Health Affairs Blog




Why Maternal Mortality Is Rising In The U.S.





Women in the World ‏ April 23, 2015

“When we launched #MerckforMothers“…we weren’t expecting to work in the U.S.” @priya__agrawal#WITW




From the Archives:


A Tale of Two Cities: Unwarranted Variation in Tonsillectomy Rates in Vermont



Video of Human Childbirth in an MRI



Cesarean rates of hospitals  |   Where can I VBAC?  |  Maternity Data Reports

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