Medicaid covers 41% of all annual births for a total annual cost of $20.5 billion. The high cost of this care drives up premiums for both businesses and families. Despite this expense, the United States has one of the highest rates of both infant and maternal death among industrialized nations. With over 4 million women giving birth each year in the U.S., at a total cost of $98 billion (over $268 million per day), childbirth and newborn care is by far the most common and expensive reason for hospitalization.
1. Unnecessary interventions: high C-section rate (national rate is 33%, WHO recommended rate is 15%),frequency of inductions and other un-indicated interventions.
2. Health Factors: increased prevalence of obesity, type 2 diabetes and hypertension.
3. Lack of integrated prenatal care: Fewer pregnancy complications and better birth outcomes could be achieved if prenatal care was more fully integrated (among all providers from the earliest stage).
4. Technology-intensive care: Results in maternal care being the most costly medical condition for both Medicaid and private insurers. Evidence does not support that this style of care increases safety. We are doing more and accomplishing less.
5. Social factors: mothers are now older, often having fertility treatments that result in higher risk multiples.
6. Lack of public awareness: Women do not have an understanding of the impact interventions have on maternal mortality and morbidity.
According to a recent study by Merck for Mothers, only 11% of Americans surveyed had heard or read anything about maternal mortality in the U.S. in the past year.
The place to start is with the most common hospital procedure in America -- the Cesarean section. A C-section is a surgical delivery of a baby, rather than a normal, vaginal delivery. Not only does a C-section typically cost twice as much as a vaginal delivery, it is more likely to result in infections, injuries and other complications for both mothers and babies.
Yet today, nearly one-third of all babies in the country are delivered by C-section. Fifteen years ago, C-section delivered only 20 percent of babies, and in the 1960s the C-section rate was less than 5 percent.
C-sections are particularly problematic when they are used to deliver babies too early. In non-emergency situations, a decision to surgically intervene has resulted in a growing number of cases in which doctors uses drugs or procedures to induce labor rather than let the pregnancy take its natural course.
About one-fourth of deliveries are now electively induced before the baby has reached full term (39 weeks). Yet research has shown that even babies born a few days too early are more likely to have problems such as developmental delays. Moreover, labor inductions before 39 weeks are more likely to result in expensive and risky C-sections, and the baby is more likely to spend time in an expensive neonatal intensive care unit.
by integrating midwives
75% European births are attended principally by midwives, while 5% of births are attended by Certified Nurse Midwives in the U.S.A.
Number of midwives needed in the U.S. to meet European levels: 120,000
100% Medicaid reimbursement for CNM care is mandatory in all states.
82% of CNM's have a masters degree.
More than 4 million babies are born each year in the United States. Nurse-midwives assist in slightly more than 7 percent of those births (CNM's account for 5%).
The Center for Healthcare Quality and Payment Reform has estimated that reducing the rate of US cesarean deliveries to the 15% recommended by the World Health Organization could save about $5 billion a year.
Our collaborative care model of midwives and physicians at Bay Area Midwifery (with deliveries at El Camino Hospital Los Gatos) has achieved a primary cesarean section rate of 6% versus that hospital's average of 16.3%(the national average is 33%.) While this practice has a low risk population of women, numerous studies have reported similar findings in women with selected risk factors.
Other practice data from our pilot project for the year 2012 shows no induction, no prematurity and a patient satisfaction rate of over 98%.
Our goal is to provide you and your family with better and more personal maternity care using an integrated team including CNM's, physicians, health educators, and health/wellness services. We believe that a woman should be empowered during her pregnancy to engage in informed decision- making regarding her care and delivery. Lucina Maternity Foundation is a registered 501 (c)3 non-profit organization.
Dr. Byrne is a Maternal Fetal Medicine physician who leads the OB/Gyn program at Santa Clara Valley Medical Center, one of the largest and most respected county hospitals in the United States. The Department annually produces over 4,500 births, 120,000 annual clinic visits, and $30m in revenue with services provided by over 55 physicians and nurse practitioners at seven regional sites.
Dr. Byrne is a clinical associate professor with Stanford School of Medicine and serves on several state/national leadership teams and advisory boards including the March of Dimes California Chapter.
Dr. Byrne has a track record of innovation and increasing productivity. Moving from the public sector to the public hospital setting of VMC in 2001, his intention was to improve maternity care for a large population of women by implementing better business models and developing high performance teams. In a rapid turnaround, the VMC program has grown in performance and is now recognized nationally for both clinical care and research. In addition, he has led clinic research as the site principal investigator in several FDA-monitored trials.
In collaboration with Stanford, the NIH has recently added Stanford/VMC to its elite network of national obstetrics research centers, the first California sites to gain this designation.
Deira Gerritsen helped co-found Lucina Maternity Foundation in 2011. As a board member, she brings a wealth of experience from both international and US markets.
Obstetrics in modern America is a contentious subject in general. Deira is one of a very small group with no affiliation to physicians, midwives, hospitals or payers. She has first-hand experience with the challenges of building the collaborative physician/CNM practice model.
Deira's goal of building a hybrid organization, where for-profit practices help fund the expansion of midwifery through the foundation is ground-breaking. Her work in the non-profit and for-profit maternal health sectors and knowledge of the legal and regulatory environments that surrounds the delivery of care is essential to the Lucina Maternity Foundation mission.
Ms. Gerritsen has held executive roles in such companies as Dow Jones, News Corporation and General Electric.
Kim brings a strong background in nurse-midwifery education and women's health policy. She is currently director of the UCSF School of Nursing's Nurse-Midwifery Education Program. Her priority is growth of a midwifery workforce focused on providing the hallmarks of midwifery care, while also addressing the shifting health care needs of any given community. The midwifery students at UCSF engage in study of successful inter-professional collaborative practice, full-spectrum reproductive health and primary care, as well as focused courses in addressing health care disparities and quality improvement methodology.
Her previous midwifery experience includes positions at the Duke University Medical Center and as Assistant Chief Midwife at Kaiser Permanente in Roseville, CA. She has been the Health Policy chair of the California Nurse-Midwives Association since 2011. Her current clinical practice is at San Francisco General Hospital.
Ralph Dickman is the current Chair of VMC Foundation, former treasurer of VMC Foundation and VP at Citi National. Ralph has been keenly interested in the work we are doing to improve services at VMC and helped to bring in a major grant benefitting the VMC Women and Children's hospital as well as Lucina Maternity Foundation.
Dickman has nearly 15 years of experience in the financial services industry and more than 20 years in the high tech marketing field in Silicon Valley. Ralph has a bachelor’s degree in English from Trinity College in Hartford, Conn. He has been active in coaching youth soccer and has served on the boards of ARH Recovery Homes and the Central Santa Clara Valley Youth Soccer League.
Dr Rydfors received his Medical degree and specialization training from Stanford University Medical Center. He is an Assistant Clinical Professor at Stanford University Medical Center and is board certified.
Dr Rydfors has extensive experience in high risk Obstetrics and advanced fertility treatment. He is the co-author of the popular "Handbook in Obstetrics and Gynecology" now in its sixth edition.
Dr Rydfors is the co-founder of the most comprehensive pregnancy mobile app available called "Pregnancy Companion" and is a Medical Consultant for several Sillicon valley start-ups. He is the recipient of the Compassionate Doctor and Patient's Choice award. Dr Rydfors is fluent in French, Spanish, Swedish and speaks some Mandarin.
With eighteen years in the Bay Area's public benefit sector, Chris Wilder serves as the Executive Director of the Valley Medical Center Foundation. The VMC Foundation supports Silicon Valley's largest and busiest hospital, the only one with a 100% open-door policy providing excellent care to everyone, regardless of their ability to pay. Since taking the position three years ago, Chris has raised more money than in the VMC Foundation's previous twelve years combined.
Before joining the VMC Foundation, Mr. Wilder most recently served as the Executive Director of City Year San Jose/Silicon Valley, California's premiere AmeriCorps program. There he managed a large staff, led a dynamic board and oversaw a fund raising effort exceeding $2,000,000 annually.
Prior to that, Chris served as Assistant Executive Director for the Vanished Children's Alliance, California's oldest and largest missing children's organization.
Today he serves as a commissioner to the Santa Clara County Child Abuse Council and is past Chair of the county's Victim Support Network. Chris also serves on the City Year advisory board, the San Jose Mayor's Gang Prevention Task Force Executive Committee and is a founding board member of the California AmeriCorps Alliance. He graduated from Stanford University's Executive Program in Nonprofit Leadership.
Linda brings to the Board experience in clinical practice, education and health care research. She retired as Professor Emeritus from University of San Francisco School of Nursing where she taught in the undergraduate and graduate programs. Her clinical practice has included serving as Director of Midwifery in the obstetrics department at Lucille Packard Children's Hospital and practicing as a staff midwife at the Ravenswood Family Health Center in East Palo Alto.
Prior to moving to California, she was the co-founder of the Baltimore Birth Center and served as the Director of the Bryn Mawr Birth Center in the Philadelphia area.
Linda has published widely on midwifery history and cultural beliefs in pregnancy and childbirth and is the author of the award-winning text, Midwifery—Community-Based Care in the Childbearing Year. While retired, she has remained active in the American College of Nurse-Midwives and is the President-Elect for the California Nurse-Midwives Association. Additionally, she is an associate editor for the Journal of Midwifery and Women's Health.
Baby - Bay Area Parent - Fall 2014
Santa Clara Valley Medical Center is on the cusp of opening a new Women and Children's Center with hopes that it will include midwives and doctors working together.
"We have the lowest C-Section rates of any major hospital in the South Bay. If you can provide that service, it means you have a high level of doctors. What we're trying to do is build awareness of those services," says James Byrne, M.D., a maternal fetal medicine specialist and head of OB-GYN at Valley Medical Center.
Read the full article here (Baby | Fall 2014 - page 18):
Mercury News Editorial 06/19/2014
Innovating is in the culture of Silicon Valley, but sometimes government agencies limited by funding or baroque purchasing rules struggle to keep up. So we're glad to see Santa Clara Valley Medical Center, one of the top public hospitals in the United States, getting back in the game after a period of disarray at the executive level.
VMC officials will unveil plans Tuesday for a new Women and Children's Center, complementing its nationally recognized trauma center and other specialties, including its neonatal intensive care unit.
The Santa Clara County Board of Supervisors and donors should rally behind the goal of raising $25 million in private funds to complete the Women and Children's Center by 2016. Consolidating women's and children's care in one specially designed section of VMC's new main hospital building makes sense for patients and parents.
San Jose: Childbirth au naturel -- new program matches midwives, doctors to reduce C-sections
By Tracy Seipel firstname.lastname@example.org
SAN JOSE -- When Alisa Burmeister got pregnant five years ago with her son, Gideon, she wasn't thinking about giving birth to a Silicon Valley startup that aimed to make childbirth less expensive and safer for babies and moms.
She simply wanted a certified nurse midwife to deliver Gideon -- with a doctor on standby in case of emergency. And she wanted assurance the delivery would be natural, with no C-section and with pain control like showers and massages instead of drugs.
The Unexpected Project Survivors Forum
A gathering of mothers and healthcare professionals turn pregnancy deaths and near-misses into purpose.
Imagine if a child's hospital visit was remembered more like a visit to The Children's Discovery Museum of San Jose. This inspiring presentation illustrates that art and play experiences can reduce stress and improve patient outcomes.
Learn more about VMC through this interactive presentation. View here.
Applying lessons learned from others (including challenges commonly encountered when organizations attempt to improve quality of medical services), We prefer to launch new maternity care practices rather than bringing either midwives or physician into an existing practice. There are clear performance benefits from allowing professionals a ‘fresh start’ with aligned vision and incentives. In addition to new practices, we will bring full turnkey care teams into existing organizations such as safety-net systems.
World Health Organization (WHO) which advocates the collaborative physician/midwife model of obstetrical care states: ‘The collaborative MD/CNM model of obstetrical care provides the best obstetrical outcomes.'" Yet, this integrated model of care is well accepted in many countries, including most of Europe but has still to take a hold here in the USA. Prior challenges in the USA have included a lack of the consolidated financial and intellectual capital required to address variations in crucial factors such as level of patient interest, midwife and physician awareness, sophistication of maternal care health systems, and discordant reimbursement for medical services. As USA healthcare reform emerges, our model is well positioned to make a large-scale impact. While there are some small practices popping up here and there, Lucina is the first to attempt this on a large scale and as part of a foundation’s mission.
From our first practice launch in January 2012 we will invest in the collection and analysis of outcomes data as part of an external validation study guided by national experts. This data will include clinical outcomes that will be compared to a control group matched for patient characteristics. The financial data will be utilized to define the impact on total cost of care for maternal-newborn services.
We will draw women from a specific geographic area near each practice using a variety of means including social media, promotion via insurer groups we associate with, and other promotion. This will be our “pull” strategy. To “push” women to this model, we will insert ourselves into standing hospitals such as safety-net systems where we place a care team.
No. A clear strength of this care model is the ability of an integrated team of professional midwives and physicians to provide care for a group of pregnant women who can range from ‘normal pregnancies’ to ‘high-risk pregnancies’. We don’t refer a patient out if she develops complications because the integrated team is present and on-site to handle.
No. This model is very flexible and high performance, thus very appealing for implementation in the safety net system. As USA healthcare reform emerges, our model is well positioned to make a large-scale impact.
Yes. One of Lucina Health Foundation’s core missions is to care for the underserved population. By inserting care teams into a safety net system we are able to make a large-scale impact much needed in this demographic.
No. The threats to private practice OB/GYN are arising from large external factors including complex regulatory and financial requirements. This is an opportunity to collaborate and better enjoy using their medical skills in a more balanced team setting.
There will be. As noted above, the current conditions will favor innovation and adaptation.
Yes. Although the CNM workforce status varies across the country, California has an excellent talent pool of trained Certified Nurse Midwives.
From institutions that are nationally recognized leaders including UC San Francisco.
Lucina Maternity Foundation is a 501(c)3 tax exempt not for profit organization recognized by the IRS.
To inquire about donating or to learn more about our programs and how you can get involved, please contact either:
Lucina Maternity Foundation
19630 Allendale Ave, # 3505
Saratoga CA. 95070