The country’s maternity care system is missing opportunities to provide better care and use resources more wisely by routinely intervening in labor and delivery in ways that interfere with, instead of promoting, supporting and protecting, innate biological processes that result in healthier outcomes for women and newborns. That is the conclusion of a major new report, Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care, released today. The unprecedented synthesis of scientific research on how hormone systems function from late pregnancy through the early postpartum period concludes that commonly used maternity interventions — such as labor induction, epidural analgesia, and cesarean section — can disturb hormonal processes and interfere with the benefits they offer.
The new report was authored by Dr. Sarah J. Buckley and released by Childbirth Connection, a program of the National Partnership for Women & Families. It synthesizes evidence about the impacts of common maternity care practices and interventions on four hormonal systems that are consequential for childbearing. It finds that a large body of evidence demonstrates that the hormonal physiology of childbearing has significant benefits for the health of mothers and babies and can optimize breastfeeding and maternal-infant attachment. But it concludes that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges. The report’s recommendations have implications for policy, practice, education, consumer engagement, and research.
“We issue this report at a moment when there is growing recognition that patterns of maternity care in the United States are contributing to unnecessarily high rates of maternal and newborn morbidity and mortality and excess costs,” said Debra L. Ness, president of the National Partnership. “It should be a wake-up call for the maternity care system and for childbearing women. We need to ensure that, going forward, we use our precious resources wisely and in ways that benefit women and babies.”
“We expect Hormonal Physiology of Childbearing to be a game-changer that accelerates efforts to improve the quality and value of maternity care while building women’s confidence in their ability to labor and give birth without medical interventions that can expose them and their babies to unnecessary risk and higher costs,” Ness continued. “We intend to mount a major effort to ensure that it reaches maternity care providers as well as women who are pregnant or are considering childbearing.”
In addition to the scientific report, today’s release includes infographics for women and for clinicians, a consumer booklet for women, and other materials. The outreach to mothers and those considering motherhood will begin via social media this week with a tweet chat and Facebook Q&A. The report and accompanying materials were funded by the Transforming Birth Fund, DONA International, and Lamaze International.
“Based on the findings from Hormonal Physiology of Childbearing, we recommend use of the Precautionary Principle,” said Carol Sakala, director of Childbirth Connection programs. “That means rigorously verifying the benefits of proposed interventions in individual circumstances before undertaking them; limiting routine practices to those of proven benefit to healthy mothers and babies; avoiding the use of interventions for the convenience of women or maternity care providers and systems; initially using less invasive measures to address challenges; and stepping up to more consequential interventions only as needed.”
The foreword, written by leaders from family medicine, midwifery, nursing, obstetrics, and pediatrics, says, in part: “This report will be retrospectively evaluated as one of the most revolutionary and influential publications on maternity and newborn care ever issued. What is remarkable is that it is not about a new technology or drug. Rather, it compiles scientific evidence that ‘less is more’ and if we get it right in the beginning there are potentially profound impacts on learning, brain development, and well-being in the child.” The foreword also speaks to the report’s relevance to improving maternal and newborn outcomes and the patient experience of care, improving population health, and reducing costs.
Hormonal Physiology of Childbearing offers a series of recommendations to optimize hormonal physiology in childbearing:
Recommendations relating to education, policy and consumer engagement:
✓ Educate all maternity care providers in the hormonal physiology of childbearing.
✓ Use effective policies and quality improvement strategies to foster consistent access to physiologic childbearing.
✓ Strengthen and increase access to care models that foster physiologic childbearing and safely limit use of maternity care interventions.
✓ Use effective consumer engagement strategies to inform women about physiologic childbearing and involve them in related aspects of their care.
Recommendations relating to care practices — whenever safely possible:
✓ Provide prenatal care that reduces stress and anxiety in pregnant women.
✓ Foster the physiologic onset of labor at term.
✓ With hospital birth, encourage admission in active labor.
✓ Foster privacy and reduce anxiety and stress in labor.
✓ Make non-pharmacologic comfort measures for pain relief routinely available, and use analgesic medications sparingly.
✓ Make non-pharmacologic methods of fostering labor progress routinely available, and use pharmacologic methods sparingly.
✓ Promote continuous support during labor.
✓ Foster spontaneous vaginal birth and avoid unneeded cesareans.
✓ Support early and unrestricted skin-to-skin contact after birth between mother and newborn.
✓ Support early, frequent, and ongoing breastfeeding after birth.
Recommendation relating to research:
✓ Identify and carry out priority research into hormonal physiology of childbearing, and routinely incorporate this perspective in maternity care research.
“Promoting, supporting, and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology health and wellness approach to the care of childbearing women and their fetuses/newborns that is applicable in almost all maternity care settings,” Sakala added. “We intend to ensure uptake of the report’s recommendations for policy, practice, education, consumer engagement, and research. We think the information it contains is important for employers and payers as well, because they want to improve care and outcomes for beneficiaries.”
The report, consumer booklet, infographics and other materials are all available online, free of charge, at: ChildbirthConnection.org/HormonalPhysiology.
Founded in 1918 as Maternity Center Association, Childbirth Connection became a core program of the National Partnership for Women & Families in 2014. Throughout its history, Childbirth Connection pioneered strategies to promote safe, effective evidence-based maternity care, improve maternity care policy and quality, and help women navigate the complex health care system and make informed decisions about their care. Childbirth Connection Programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation. More information is at www.ChildbirthConnection.org or Transform.ChildbirthConnection.org.
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.