Issuu on Google+

WHO Collaborating Centre for Development of Midwifery Services and Education

Successful Experience in Midwifery in Puerto Rico: Reduction of C-section and Humanization of Births

Irene G. dela Torre, CNM, MS April 26, 2013


The Cesarean Epidemic US rate 2004 =29.2% 2010 =32.8% PR rate 2004 = 47% 2010 = 46% PR CNM rate 2004 = 8% 2010 = 12%


Primary Cesarean Rate and VBAC Collected from Revised (2003) U.S. Birth Certificates, 2005-2010 Primary Csection Rate

VBAC Rate

# of States Using Certificate

% of Total Birth

2005

24.5

10.1

12

31

2006

23.5

8.5

19

49

2007

23.4

8.3

22

53

2008

23.8

8.4

27

65

2009

23.8

8.4

28

66

2010

23.6

9.2

33

76


Primary Cesarean Rate and VBAC collected from Revised (2003) U.S.Birth Certificates, 2005-2010

80 70 60 50

Primary VBAC % of Total Birth

40 30 20 10 0 2005

2006

2007

2008

2009

2010


The Puerto Rico Challenge From 1995 ( start of “reforma” ) to 2006 , there was a 30% increase in C-section rate , 29.7% to highest 49.2%

The MOD gave PR a grade of “F” for prematurity rate ( and consequently high infant mortality rate)

Increased induction and no TOLAC in private MD and hospitals


The Response MOD island wide campaign to reduce elective induction prior to 39 completed weeks of gestation

Inne-CESAREA.org A student of public health initiative , multi organizational, massive media campaign against un-necessary c-section

CNM – public education, prenatal care with empowerment of women about choices, no elective induction, option for VBAC


The Midwife Response • MIDWIFE means “with women” • Midwifery Model of Care • Midwife-led system of care • Evidence : 2011 ACNM Benchmarking Project – Among small services (0-99 births/year) – “Best practice” in 4 core perinatal measures – Induction of labor <10% – Primary cesarean <15% – Episiotomy < 2% – Breastfeeding before discharge > 75%


HUMANIZED BIRTH EXPERIENCE A BASIC HUMAN RIGHT


The Cycle of Birth Experience Family involvement

Personalized prenatal care

Group Prenatal Care


Is humanized birth possible in a hospital setting? • Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level


YES, OF COURSE!!! Husband support

Midwife / doula

Family


You can make it happen! Husband support Family and midwife Happy Birthday!


Midwife and family support during labor and birth in hospital setting Early Labor

Active labor

Birth


Humanized birth in a high volume, low resource setting


High risk humanized birth in low resource setting?

Mom having twins

Grandma with first twin

Second twin born breech


Homebirth / Waterbirth


Homebirth A very intimate private experience


Or a shared social experience


On-going Care


Birth in the place you desireâ&#x20AC;Ś


Meet our Midwives, tour the Birth Center, explore your optionsâ&#x20AC;Ś. Birth Center

Home Birth

Mobile Clinic

Happy Birthday Mobile


Cuenta tus bendiciones todos los días, agradece en tu corazón

Count your blessings everyday, thank with your heart por ayudar a traer una nueva vida… for helping bring a new life Sonrie... eres una Partera! Smile… you are a Midwife!


Puerto rico humanized birth