Although recent high quality research supports the value and safety of planned home birth for healthy low risk women (Cheney, M. et al, 2014; Olsen, O.& Clausen, J., 2012; de Jonge, A., van der Goes, et al, 2009; Janssen, P., & Saxell, et al, 2009), in the US planned home birth continues to be controversial and, although the rate of planned home birth is increasing, only slightly more than 1% of women in the US give birth at home. (MacDorman, M., Matthews, M. & DeClerq, 2014). Professional guidelines, health and hospital policy, legal and ethical issues, insurance coverage, regulation and licensure of birth attendants, and access to home birth reflect in powerful ways the controversy. In 2011, the major stakeholders including obstetricians, pediatricians, midwives, nurses, childbirth educators, lawyers, legislators, insurance companies, birth advocates, representatives from government agencies and women met to address their shared responsibility in providing safe maternity care across birth settings. This first Home Birth Summit set the stage for an unprecedented and effective collaboration of stakeholders that has raised awareness, and created policy and practice change. The purpose of this session is to present the process of finding common ground related to home birth and the policy and practice changes that resulted from this work.
A steering committee of major stakeholders planned the first Home Birth Summit with Future Search, an organization that helps stakeholders from diverse and often opposing backgrounds and viewpoints to untangle the issues and find solutions. Seventy stakeholders with influence and authority were invited to participate. The goal was to develop “common ground”.
The Home Birth Summit stakeholders agreed on nine Common Ground Statements related to: autonomy and choice, inter-professional collaboration and communication, reductions in disparities and equality in access to care, regulation and licensure of home birth providers, consumer engagement and advocacy, inter-professional education, liability reform, research, data collection and knowledge translation, and physiologic birth. The statements provided the foundation for action.
The presentation will discuss these common ground statements and 12 major outcomes:
- ACNM and ACOG approved joint guidelines for Transfer (home to hospital).
- Presentations nationally and internationally (International Congress of Midwives, Normal Birth conferences, ACNM, AWHONN, Lamaze International, Sigma Theta Tau Research, ACOG conferences).
- ACNM’s consumer statement on normal physiologic birth and the BirthToolKit (Oct. 2014).
- ACNM’s Healthy Birth Initiative.
- A renewed focus on the importance of normal physiologic birth from major organizations, like AWHONN’s Go the Full Forty (2012-ongoing).
- ACOG updated their statement on planned home birth acknowledging women’s right to choose their place of birth and calling for seamless transfer of women from home to hospital. August 2016.
- The Institute of Medicine meeting on Place of Birth was held in March 2013.
- The Journal of Clinical Ethics released a special issue on planned home birth in October 2013
- An increased number of insurance plans cover planned home birth
- An increase in research, both qualitative and quantitative, on planned home birth including the largest ever study of US planned home birth (Cheney, et al, 2014), and a MANA dataset on home birth.
- Publication of articles in major nursing and medical journals.
- The Lancet special issues on midwifery in July 2014 and summer 2016.
- ACNM and ACOG joint statement on collaborative practice with both nurse midwives and certified professional midwives.
The model of finding common ground among stakeholders of influence and authority holds promise as a creative and effective way to find solutions when there are competing interests that make evidence based policy and practice change difficult. This might be an effective strategy for nursing to consider.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters