CCM’s Commitment to Quality Maternal Newborn Care (QMNC)
California College of Midwives’ members are committed to a focus on health promotion and disease prevention by providing the highest possible quality of maternity services to an essentially healthy population of childbearing women.
The CCM collectively views pregnancy as a normal life event, one that is generally safe when the biological, psychological and social needs of pregnant and laboring women are met within the context of functional healthcare system.
Quality Maternal and Newborn Care (QMNC) firmly places the needs of women and their newborn infants at the center of the maternity care system. QMNC is a worldwide movement in conjunction with the International Congress of Midwives (ICM) to re-orient the current obstetric-centric system that focus primarily on interventions to a new and whole-system approach of mother-baby centered care that equally provides skilled care for all childbearing women, regardless of the risk category they find themselves or their babies.
This goal is based on a definition of midwifery that takes account of skills, attitudes and behaviors, rather than specifically defined, often rigid and highly limiting professional roles. When responsibility for the wellbeing of a childbearing women and her new baby are divided up between many different professions and professional care providers, the natural continuity of care is lost.
As a result there is often a maddening duplication of caregiver efforts, while badly needed forms of care and personal attention are lacking. The unproductive expense generated by duplication and the escalation of unmet needs into preventable complications further prevents the system from correcting itself.
The QMNC movement recognizes an urgent need to shift away from the current system of fragmented maternal and newborn care. For the last century, the official focus of maternity services has been on identifying and treating pathology. However, childbearing women with high-risk pregnancies or serious complications constitute less than 30% of the childbearing population, while the vast majority are healthy women with normal pregnancies who give birth at term (over 70%).
Unfortunately, the enthusiasm and economic incentive association with providing highly complex and technologically-sophisticated medical services to the 30% of mothers with complications has produced a system that largely ignores the much less expensive needs of the majority. As a result, healthy women routinely receive highly-fragmented care during the pregnancy and postpartum periods.
From an economic and social perspective, an even greater problem is the current system’s inability to effectively support normal vaginal childbirth and the new mother-new baby phase immediately following the birth. The unfortunate result is the worldwide overuse of Cesarean surgery, which is at 33 to 50% two to four times higher than the optimal level of 10 to 15% as determine by research conducted by the WHO.
The role of midwifery in meeting Important social and economic needs of Society relative maternity care of healthy women with normal pregnancies
The new model would require a return to the multi-disciplinary approach that was the norm in the US before it was purposefully eliminated by organized medicine in 1910. This multi-disciplinary model is the same type of cooperative and complimentary relationships that were historically used in other developed countries, where obstetricians, family practice physicians, and professional midwives all worked together and providing care in a variety of settings.
In such a system, the individual management of pregnancy and childbirth would always be determined by the health status of the childbearing woman and her unborn baby, in conjunction with the mother’s stated preferences, rather than the occupational status of the care provider (obstetrician, family practice physician, or midwife) or the planned location of care
For healthy childbearing women this means receiving the physiologically-based care. As provided by professional midwives, healthy women have 2 to 10 times less obstetrical intervention than low-risk women in hospitals who labored and gave birth under customary medicalized protocols. Of even greater importance in human suffering and economic expense, physiologic childbirth practices were associated with a 6-fold decrease in Cesarean section (under 4%), which reduced the cost of care by 50 to 150%.
As measured by the outcome statistics of four statistical categories – unattended births, lay midwife-attended, professional midwife-attended out-of-hospital and hospital-based birth attended under standard medical protocols by obstetrician and nurse midwives — the most efficacious strategy for preventing maternal and perinatal mortality and morbidity consists of three simple aspects of maternity care that balance safety and cost-effectiveness:
(1) Access to risk-screening, prenatal care and referral to medical treatment whenever necessary
(2) The presence of an experienced birth attendant during labor, birth and immediate postpartum
(3) Access to hospital-based services for complications or if requested by the mother
The California College of Midwives supports QMNC in addressing and eliminating these problems and in helping to create a 21st century maternity care system that is safe, cost-effective and able to met the needs of all segments of the childbearing population. This goal is nothing less than affordable, accessible, women-centered, mother-baby friendly maternity care with seamless access to comprehensive obstetrical services as medically indicated or as requested by the childbearing woman.
For an essentially healthy population, the most efficacious form of maternity care is always the method that provides “maximal results with minimal interventions”. This is defined as a beneficial ratio of interventions to outcomes for each childbearing woman. It factors in mortality and morbidity rates for mothers and babies both, as well as the immediate, delayed and long-term cost-effectiveness.
The ideal maternity care system seeks out the point of balance where the skillful use of physiological management and adroit use of necessary medical interventions provides the best outcome with the fewest number of medical/surgical procedures and least expense to the health care system.
To achieve the goals of QMNC requires integrating the traditional principles of physiological management with the very best advances in obstetrical medicine to create a single, evidence-based standard for all healthy women. This model of care should apply to all categories of birth attendants and in all settings and include the use of best and most advanced obstetrical interventions whenever they are necessary to treat complications or if requested by the mother.
Mastery in normal childbirth services for healthy women with normal pregnancies means bringing about a good outcome without introducing any unnecessary harm or unproductive expense.
Ultimately, maternity care is always judged by its results — the number of mothers and babies who graduate from its ministration as healthy, or healthier, than when they started.
Mamoud Fathalla, 1998 Egypt: “The question should not be “why do women not accept the service we offer” but “why do we not offer a services that women will accept”.
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