Advances: Family-Centered Maternity Care (2000)

Table of Contents:

• The Evergreen Story: Moving Toward Family-Centered Care
• Family-Centered Care: A New Paradigm
• Parents as Partners: Helping Shape Care at Boston Medical Center
• Becoming A Baby-Friendly Hospital: The Process of Change
• Supportive Language in Family-Centered Maternity Care
• Parent Advisory Council Offers Valuable Insights at Newton-Wellesley Hospital
• Rural Outreach Resource Mothers: Mothers Helping Mothers
• Involving the Community in Program Design and Implementation
• Spotlight on Canada

Family-Centered Maternity Care: Time to Renew the Commitment

This issue of Advances is devoted to family-centered maternity care÷a subject of immense importance, and of increasing concern, to many health providers, women, and families today.

Family-centered care, in many ways, has its roots in maternity care. Between 1960 and 1980, mothers began to seek changes in maternity care. They challenged high-tech approaches to labor and delivery in hospitals. They asked that fathers have the opportunity to be present in the delivery room. These family advocates spoke out for liberalizing visiting policies. They helped improve childbirth education and breastfeeding support. The concepts of single-room maternity care and mother-baby nursing began to emerge.

Soon, however, this promising trend was interrupted. The term "family-centered maternity care" was trivialized often becoming little more than a hospital marketing slogan. There developed a misguided perception that French provincial furniture and pretty wallpaper were key elements of family-centered care. Single-room maternity care and mother-baby nursing did not become, as had been hoped, a standard accessible to all women.

Many community practitioners and hospital staff members and managed care organizations do not view listening, communication, and relationships as essential elements of maternity practice. They fail to understand the importance of recognizing women's values, priorities, and concerns. They do not share information in useful and affirming ways.

Finally, many practitioners and administrators, beset by financial concerns, do not realize that listening to women will not lead to unreasonable demands for improved services. Asked what they want in maternity care, childbearing women from all settings and in all circumstances consistently provide the same response: they want to be treated with dignity and respect. When women express dissatisfaction with care, they often point to the absence of respect and the resultant dehumanized care. Such women find a spokesperson in Merlinda Neal, a resource mother in a rural outreach program in Georgia who is featured in this issue. In describing the physician who oversaw the birth of her first child, Ms. Neal said, "He treated me like . I wasn't a person, a human being. It was all about what he wanted."

Sobering Statistics

Anyone who remains unconvinced of the need to improve maternity care in the United States need only read some sobering statistics:

• One in six children is born to a mother who did not receive prenatal care in the first three months of pregnancy.
• Nearly 10 percent of all babies born in the United States are considered low birth weight (i.e., under 2500 grams).
• The percentage of new mothers who breastfeed their infants is low and is marked by substantial racial disparities.
• Sixty to sixty-five percent of White mothers breastfeed compared with only 25%-30% of Black mothers.
• The current infant mortality rate in the United States is above 8%, placing this country 18th in the industrialized world.
• Today in America, 1 in 138 infants will die before their first birthday.

A Multifaceted Rationale

Why is it essential that we promote the practice of family-centered care in women's health care, and particularly in maternity care? A compelling case can be made on the basis of cost alone. The average medical cost to care for a premature infant is more than $500,000. Lack of prenatal care and low birthweight are directly associated with premature birth and an extended perinatal hospital stay.

There are other equally important justifications. For example, women are the primary health care decision makers for themselves, their children, and their families. Women are also community leaders and builders.

Moreover, the way women are treated during their pregnancies and the early months of their infants' lives, coupled with the quality of the educational programs and support for parenting and good health that are available to them, have a profound effect on their mental health and self-esteem, their ability to parent, and their perceptions of the health care system. Such experiences have a lasting impact on how a woman interacts with the health care system, and, indeed, on whether or not she will even seek care.

Prenatal and maternity care, in summary, provide an opportunity to connect with women, build on their confidence and competence, and ensure their health and that of their children. In maternity care, health providers also have an opportunity to reach out to fathers at a very impressionable time and involve them in the care and development of their infants.

A Two-Way Street

Hospitals and community providers today are under enormous pressures to reduce costs, rethink systems of care, build new community relationships, develop new approaches to professional education and research, and work within constraints posed by managed care.

Women and families, even those living in complex and demanding social circumstances, can help hospitals find solutions to these challenges. They offer unique perspectives and expertise about the experience of care, the design of programs, and the formulation of health care policy.

Family-centered maternity care, in other words, is a two-way street. In return for reaching out to women and making a commitment to family-centered care, hospitals gain important allies women who will help shape their programs and policies and become loyal supporters. Greater community good will is another important result.

Issue Overview

The articles in this issue of Advances provide an overview of the encouraging progress being made in family-centered maternity care in hospitals and other sites nationwide. The articles deal with topics such as the following:

• A 16-year process of change in the Family Maternity Center at Evergreen Medical Center in Kirkland, Washington.
• A successful breastfeeding education and support program at Boston Medical Center, (BMC), as well as a description of "Parents as Partners," a program in which parents have taken active roles within the Department of Pediatrics at BMC.
• The creation and initial accomplishments of a parent advisory council for maternity services at a community hospital.
• Two model peer support programs÷a home visit intervention designed to support young, inner-city African-American mothers, and a resource mothers' support program for families living in rural medically underserved communities.
• Family-centered changes in maternity care now occurring in Canada, including the recent publication of the fourth edition of National Guidelines for Maternity and Newborn Care.

Tools You Can Use

In addition to articles that recount the experiences of others, this issue contains two tools that readers may find helpful in examining the status of family-centered maternity care in their own communities.

One of the first steps in initiating or expanding family-centered change in maternity care is to assess current services and resources. The Institute for Family-Centered Care has designed a checklist, Collaborating with Childbearing Women and Families to Build a Quality, Accessible, Cost-Efficient Systems of Care: A Self-Assessment Inventory, for this purpose. (The publication, Maternity Care: Resources for Family-Centered Practice, offers more in-depth guidance, a series of assessment tools, and training materials that can be used in planning for, implementing, and evaluating family-centered maternity care. It is available from the Institute, see the Resource List).

Health providers and families wishing to promote family-centered changes in maternity care may find it helpful to articulate a core set of values. "What Is Family-Centered Care?" which appears in this issue, may be helpful in this respect. It defines family-centered care and provides a set of core concepts that have been adopted by many hospitals.

Conclusion

As the articles in this issue demonstrate, family-centered initiatives are offering examples of innovation at health facilities in a variety of settings today. Families are collaborating with health care professionals to improve policies and programs, train physicians and other health providers, redesign health care facilities, and enhance services. At the same time, the statistics cited earlier, coupled with the anecdotal experience of countless providers and parents today, indicate that there is much work to be done before all women have access to respectful, supportive maternity care.

We hope that the experiences of other providers and families reported here, as well as the guidance resources described above, will help readers work to initiate or expand the momentum for family-centered maternity care in their communities and agencies.

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