Turning the Tide – Consensus Panel Statement
The 2011 Turning the Tide: Balancing Birth Experience and Interventions for Best Outcomes consensus conference brought together a diverse group of relevant stakeholders in maternity care to present and discuss evidence regarding the impact medical interventions, specifically electronic fetal monitoring, induction of labour and epidural anesthesia, have on a woman’s experience of labour and birth. The conference was hosted by BC Women’s Hospital’s Cesarean Task Force and the Power to Push Campaign, the UBC Collaboration for Maternal and Newborn Health, and Perinatal Services BC (PSBC).
In the last decade, several large surveys have been carried out asking women about their labour and birth experience. In Canada, a survey of women’s perceptions and experiences of pregnancy, labour, birth, and early postpartum was published in 2009, What Mothers Say: The Canadian Maternity Experiences Survey. In the US, a similar survey of women’s experiences was published in 2002, 2006 and 2008, Listening to Mothers. These two landmark surveys raised questions, which we attempted to address at this two and a half day consensus conference.
The presenters, panel members and audience participants were asked to consider the following questions:
- How do we promote women’s autonomy and control regardless of risk?
- How do the following interventions impact the birth experience? What is the optimal use of each intervention? (Continuous electronic fetal monitoring; Induction of labour at term; Epidural analgesia)
- How do we build partnerships with women and their families to improve delivery of care?
- What support is required from government, hospitals and Perinatal Services BC, to help balance interventions and the birth experience?
The conference provided an opportunity to listen to women and consult with experts, to learn about important factors that contribute to a woman’s positive birth experience, and to develop consensus on the most relevant factors. Audience participants were largely from BC, but also included participants from across Canada and the United States; the care providers attending were practicing in urban centres, small towns and in rural and remote locations. The 166 audience participants were comprised of 22% nurses, 19% midwives, 17% physicians, 7% doulas, 13% students (midwifery, nursing and medicine) and 23% other (educators, researchers, public members).
The 16 member panel (see page 16 of the statement), included representatives from rural, regional and tertiary centers, and included obstetricians, nurses, family physicians, and midwives, as well as an anesthetist and two consumer representatives.
During and following the conference presentations, panel members convened to discuss the consensus questions and to develop a first draft of the consensus statement. The first draft was presented to the audience participants on Friday, May 13th, 2011. The feedback from the draft and the final panel deliberations were incorporated into this panel consensus statement.
SUMMARY OF KEY RECOMMENDATIONS
- Support women to be active participants in their care and an integral part of the care team in decision-making and self-care. Develop and maintain true therapeutic alliances with women based on best evidence, clinical expertise and a woman’s stated choices and values. Inform the woman of equipoise (true uncertainty) where it exists and best practice when the evidence is clear.
- Develop and implement province-wide strategies for culturally sensitive care and support to foster partnerships with women where language or cultural barriers exist. Ensure equal access and support for women who are marginalized for social, health or geographical reasons. All first births should have the benefit of an “MSP funded” doula to give continuous, culturally sensitive care (preferably in a woman’s first language) and support during labour.
- Reinvent prenatal education for both how it is provided and what information is presented. Develop innovative, web-based tools designed to provide easy access to information about childbirth, the process of decision-making, and to help women understand the meaning and magnitude of individual risk factors. Consider group prenatal care to increase opportunities for information sharing and knowledge acquisition and to allow women to form partnerships with one another.
- Redesign the education curriculum for nurses, midwives and physicians and ensure that training of all maternity care providers takes place in an interdisciplinary model that recognizes the value and contribution of each member of the team. Inter-professional education opportunities should begin with all maternity care learners and continue throughout their professional lives.
- Address barriers to inter-professional practice with the development of alternative funding models for collaborative primary care practice, especially in rural and/or under serviced communities. Encourage dialogue between the professional colleges of nursing, midwifery, and medicine to examine barriers to collaborative practice within existing professional models of care.
- Accelerate the evidence-based use of intermittent auscultation (IA) for fetal monitoring in low-risk pregnancies. Audit and publish induction of labour practices and implement quality improvement initiatives. Implement the use of mobile, low-dose epidural techniques and mobile fetal monitoring telemetry to support physiological birth. Create multi‐disciplinary teams mandated to implement quality improvement programs.
- Provide feedback on obstetrical indicators to individual hospitals using Robson’s Criteria. All intervention rates and outcomes, specific to each hospital in the province, should be published in the public domain for transparency.
Thank you to the 16 panel members for all their hard work and feedback on the draft statements. Also, thanks to all the speakers for their thought-provoking presentations that helped shaped the consensus draft.
Nardia Strydom, MD
Lee Saxell, RM, MA and Karen Buhler, MD