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%.
at Santa Clara Valley Medical Center
Inspired by the success of the Lucina Maternity pilot program at Bay Area Maternity, Valley Medical Center Foundation is bringing this model to Santa Clara Valley Medical Center to improve infant morbidity and mortality rates and reduce costs to public and private payers.
This model demonstrated profitability and positive outcomes within six months of implementation. It was developed by the Lucina Health Foundation and is led by the Chief of Obstetrics at VMC, Dr. James Byrne. Dr. Byrne is on the faculty at Stanford and is a member of the California Quality Maternal Care Collaborative.
We are committed to establishing Lucina Maternity as the core element of an evolving mother-child service line for VMC that will drive up patient satisfaction, add more private insurance to the payer mix and increase VMC's status within the community.
Though VMC is already a local and state leader in low C-section and intervention rates, we are committed to further reducing these, as well as rates of pre-term delivery, while providing a more satisfying birth experience for Moms and their babies at a lower cost to the health care system.
This model is already being implemented within VMC on a small scale now. By the fourth quarter we will employ 2 full time midwives (CNM's) within the existing structure to integrate with our team of physicians. This team will be able to deliver 500 babies per year. Within the first half of 2015 this practice will be fully staffed with 4 full time CNM's and 2 physicians. These highly trained professionals will share decision-making, placing the patient at the center of care. In a general population, most pregnancies are uncomplicated. As the pregnancy progresses through gestational stages, the Lucina team, in partnership with the woman, assesses the woman's individual health status, plan her care needs, and appropriately intervenes when indicated to improve outcomes. We want to replicate the success of the pilot project at VMC and ultimately nationally.individual health status, plan her care needs, and appropriately intervene when indicated to improve outcomes. We want to replicate the success of the pilot project at VMC and ultimately across the nation.
Convert 300,000 square foot inpatient facility to acute and intensive care centre for women and children.
Major public art initiative will transform existing building into welcoming, magical environment for patients.
New family and guest gathering areas.
Introduction of new maternity care model, providing integrated care by a team of midwives and physicians.
Upgraded rooftop paediatric therapy playground.
Private, single-family mother and baby suites.
San Jose may be without a children's hospital, but it's not without the care one provides. Santa Clara Valley Medical Center has been the de-facto children's hospital of San Jose for generations. As part of a fully integrated County public health system, VMC pediatric clinics had 125,000 visits in 2013, primarily serving low-income kids. VMC operates the only stand-alone Pediatric ICU in San Jose. As a level 2 pediatric trauma center, major pediatric injuries already come through the doors of the Emergency Department. From managing chronic diseases like diabetes and respiratory illnesses, to major burn, spinal cord and brain injuries, VMC provides the highest level of care to kids.
Moms and babies are similarly well-served by VMC's advanced level of services. VMC is one of the largest birthing centers in California, with 3500 babies born in 2013, and sees 100,000 OB/ GYN clinic visits from expectant moms each year. In the most recent survey, the California Office of Statewide Health Planning rated VMC as one of the safest hospitals in California to give birth due to low Cesarean section rates, and VMC was ranked seventh in a UC Davis survey for breastfeeding rates of all hospitals statewide. The Level III Neonatal Intensive Care Unit provided care to more than 300 prematurely born and severely ill babies in 2013, and was chosen by the March of Dimes to house the Northern California NICU Family Support Center. Of all regional Level III NICUs in California, VMC has the highest survival rates for babies born without major morbidities.
When we add our collaborative care maternity model into this mix, we will further reduce costs, add a new patient mix to the hospital and increase satisfaction for patients and providers at VMC.
Over a 3-year period, the clinic will serve 3,300 patients (1,800 Medicaid and 1,500 privately insured) using 4 certified nurse-midwives and 2 obstetricians in an integrated and collaborative outpatient clinical practice at Santa Clara Valley Medical Center with deliveries at VMC.
The target population will include pregnant women with a variety of risk factors. These include risk factors for preterm birth and other pregnancy complications such as low socioeconomic status, domestic violence, and racial characteristics linked to health care disparities.
Pregnant women who enter prenatal care in our safety-net health system will be identified and routed into this program at the time they contact the patient call center seeking an initial obstetrics prenatal care visit. Patients will be screened and evaluated by nurse-midwife and physician provider staff for risk factors using well-established national criteria published by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in the Guidelines for Perinatal Care.
Patient-centered care and coordination with a multi-disciplinary group of providers (nurse-midwives, obstetricians, perinatologists) and staff (registered nurses, health educators, social workers, nutritionists).
Integrated and collaborative care of patients based on shared decision-making, with the patient as part of the team.
Use of HIPAA clinical guidelines and clinical decision support tools by all providers and staff.
Collection of HIPPA compliant process- of care outcomes data for quality improvement and to guide best practices.
Total one-time investment, program will be cash-flow positive in six months and fully self sustaining from that time onward.
Funds will be used to build and staff the outpatient clinic and to provide full scope maternity care and support services that are evidence based and individualized to the health status and psychosocial needs of the woman and her family.
|10 full time (FTE) direct staff for the Lucina Maternity model|
|3 Medical Assistants|
|2 Health Education Specialists|
|1 Clinical Nurse II at (.6 FTE)|
|1 Maternal-Fetal Medicine Specialist (.4FTE)|
|1 Obstetrician (.6 FTE)|
|4 Certified Nurse Midwives (CNM) (at 3 FTE)|
|6 in-kind with VMC and VMC Foundation staff including a Health Center Manager, three Health Services Representatives (one senior), financial manager and business developer.|
One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. 68% of births are attended by a midwife in Britain and 45% in the Netherlands, compared with 8% in the United States. When utilized correctly, interventions go down, costs decline and patient satisfaction increases.
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 launch Lucina Maternity Foundation in 2011. As Executive Director, she brings a wealth of experience and strong record track record of success in multiple industries in both U.S. and international markets. Deira's executive leadership skills, start-up experience, and passion for pediatric non-profit organizations are key assets for Lucina.
Deira has been developing and driving processes for business development for over 20 years in Canada, Asia, the UK and the U.S. Deira was part of the launch team for such brands as STAR TV, MTV Asia, and CNBC Asia and held executive roles in such companies as Dow Jones, News Corporation and General Electric.
Under her own consulting company, eLucid8, LLC – Deira has helped to develop brand, marketing and distribution strategies for products and companies of much smaller sizes, thus grasps the key elements of growing a business whether they are contained within Fortune 500 companies, privately funded or non-profit oriented.
In the non-profit sector, Deira has worked with Children’s Hospital in Boston, MA, CureSearch in Washington DC and The Hospital for SickKids in Toronto.
Leslie joined Lucina Maternity Foundation in 2011 as Treasurer of the Board of Directors. In September of 2012 she accepted the role of collaborative practice development. She is a certified nurse midwife and Fellow in the American College of Nurse-Midwives (ACNM). Currently retired, as the Director of the Nurse-Midwives of San Francisco at San Francisco General Hospital and Clinical Professor at the University of California, San Francisco Department of OB/GYN she was responsible for a large academic practice and was active in teaching medical students, residents and nurse-midwifery students. Her research has examined the outcomes of midwifery care to women from vulnerable populations in California and Mexico.
She is active in midwifery at the state and federal levels, participating in the California Maternal Quality Care Collaborative on the Executive Committee, and has served on of the BOD of the California Nurse-Midwives Association.
Leslie's experience as a practicing midwife and researcher lend an important perspective to Lucina. Her work has led her to believe that integrated and collaborative models of maternity care will be the best future for women and families’ health. Her research experience will assist Lucina in the effort to measure outcomes, in order to guide the foundation in refining the "best practice" approach utilized in this model of care.
Swarup joins the Lucina Board of Directors with a diverse background that spans government, academia, the corporate and start-up worlds
With a BSC in Mathematics and a PhD in computer science, Swarup was a member of the start-up team that launched Ask Jeeves and participated in its growth to a public company with more than 800 employees.
Swarup has many years practical experience building information retrieval systems as well as a Masters specializing in database and information systems. As we develop an industry standard in EMR for the maternity sector, these skills will be called upon.
Swarup also holds an MA in Social Anthropology, which helps his understanding of the inevitable struggle over common ground when different paradigms, each with their own implicit assumptions, meet. It is this knowledge set that provides a rich resource to Lucina as we navigate the many different views and stakeholders in the areas we seek to change and improve.
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