data – Doula School Canada

2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health

[vc_row][vc_column][vc_column_text title=”2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health” css=”.vc_custom_1718910346497{margin-bottom: 0px !important;}”]In the United States, publicly-funded healthcare is provided through Medicaid and CHIP (Children’s Health Insurance Program). These are joint programs of state and federal governments that provide health insurance to low-income people, children, people with disabilities, and pregnant people. These eligibility parameters mean that there are individuals who are eligible for coverage during their pregnancies and the postpartum period who are not eligible at other times. Medicaid finances 41% of births in the United States. Federal law requires states to provide coverage up to 60 days postpartum. A bill in 2021 gave states the option of participating in an extended coverage program offering coverage up to one year postpartum.

In May 2024, Centres for Medicaid and Medicare Services (CMS) released an infographic summarizing beneficiaries’ maternal health data. CMS collects demographic data on age, race and ethnicity, and geography. They collect outcome data on maternal mortality and severe maternal morbidity (SMM), underlying causes of maternal mortality, dental care access, postpartum contraceptive utilization, spacing between pregnancies, chronic conditions, timeliness of prenatal and postpartum care, smoking, behavioral health and substance use, neonatal abstinence syndrome, postpartum depression (PPD), preterm birth, and low-risk cesarean delivery. Additionally, they collect health system data on healthcare service provider distribution, state quality improvement activities, and state participation in an opt-in extended postpartum coverage program.

Key Take Aways

The data highlight key areas of disparity for Medicaid beneficiaries and provide an important road map for healthcare policymakers and system designers regarding where care could be enhanced. For example, the data show that Black birthers experience mortality 2.6 times more often than their white counterparts. This finding corroborates other research and supports advocacy efforts for publicly funded doula care as an intervention to reduce Black maternal mortality rates. Another useful observation is that birthers under the age of 19 experience higher than average rates of PPD (22% compared to an average of 17%). This suggests that in addition to universal PPD screening, additional attention should be paid to this group during the postpartum period.

This 9-page resource provides invaluable information to support US birthworker advocacy on expanded access to birth and postpartum doula care, freedom of provider choice and birth location, and mental healthcare. For birthworkers in Canada and other jurisdictions, it is an illuminating example of what can be learned from comprehensive demographic and outcome data collection practices.

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

Why Is Evidence-Based Research a Vital Skill for Birthworkers?

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Why Is Evidence-Based Research a Vital Skill for Birthworkers?

[/vc_column_text][vc_separator color=”white”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1645285895328{margin-bottom: 0px !important;}”]The term “evidence-based” gets used a lot more than it gets explained. “Evidence-Based medicine” is a movement within health care practice that started about 30 years ago. It is a shift in approach to relying on the best available research data to support clinical decision making regarding testing, diagnosis and treatment. It differs from the previous practice in medicine and other health professions where teaching was largely apprenticeship-based, and physicians relied on their personal clinical experience to determine patient care plans (Masic et. al., 2008).[/vc_column_text][vc_column_text css=”.vc_custom_1645285507272{margin-bottom: 0px !important;}”]Relying upon scientific evidence to make decisions has the potential to improve patient outcomes because decisions are made based on clinical data that clearly show what happened most of the time when certain choices were made or methods used. It all sounds logical and straightforward, but evidence-based care is actually more challenging to implement than it sounds and it is not without controversy. In reality, evidence-based care happens very inconsistently (Lehane et. al., 2019).[/vc_column_text][vc_column_text css=”.vc_custom_1645286010844{margin-bottom: 0px !important;}”]This is where doulas have the potential to help. There is no organized system whereby new research makes it into the hands of healthcare professionals. There can be quite a lag between new, credible research being published and health care professionals updating their practice to align with it (Lehane et. al. 2019, Soliday and Smith, 2017). It takes physicians an average of 17 years to change their practice in accordance with new research. [/vc_column_text][vc_column_text css=”.vc_custom_1645285541602{margin-bottom: 0px !important;}”]Additionally, while unintentional, an evidence-based approach can be in contradiction with a patient-centred, individualized approach to care. The standard 15 minute medical appointment does not make it feasible to conduct research for each individual. This means that even providers who are staying apprised of new research developments may provide “one-size fits all” care due to resource constraints.[/vc_column_text][vc_column_text css=”.vc_custom_1645285557316{margin-bottom: 0px !important;}”]Institutional policies and legislations are often even slower to change with new evidence. For example, while evidence has been available for quite some time that routine antibiotic eye ointment for newborns is unnecessary, this is still a hospital requirement in many jurisdictions. If providers feel pressured by institutional policy, these interventions are often framed as requirements. From the provider’s perspective that is true, however the patient always has the right to refuse treatment. Often, legislation and institutional policies only change when concerned patients and healthcare providers call for change (Soliday and Smith, 2017).[/vc_column_text][vc_column_text css=”.vc_custom_1645285573376{margin-bottom: 0px !important;}”]Doulas who are skilled at evidence-based research can support clients to gather and interpret credible scientific information that is specific to their unique needs and circumstances. Clients equipped with this information are well-positioned to self-advocate by speaking a language the provider understands (Soliday and Smith, 2017). I know from lived experience as a Queer, Black woman that being an informed and educated healthcare consumer makes for much more empowering healthcare experiences.[/vc_column_text][vc_separator color=”white”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1645286312153{margin-bottom: 0px !important;}”]On February 24 at 6 PM EST, I am hosting a webinar on conducting evidence-based research in birthwork. The webinar will focus on preparing a strong literature review for perinatal informational support. A literature review refers to the process of compiling and synthesizing all of the current and relevant scientific information that is available on a topic. Analysis involves assessing the quality of each source and summarizing the complete body of literature. [/vc_column_text][vc_column_text css=”.vc_custom_1645285639985{margin-bottom: 0px !important;}”]During this session, we will discuss what exactly is “evidence”. We’ll go over the different types of health research evidence that exists, as well as how to determine which sources are credible, and how different sources can vary in quality. Participants will also learn about the different types of bias that can crop up in how we search for and analyze information, as well as how to spot and reduce bias in their own research.[/vc_column_text][vc_column_text css=”.vc_custom_1645285655944{margin-bottom: 0px !important;}”]Using real scenarios provided by DTC members and webinar attendees, we’ll walk through how to turn a client concern into an unbiased research question and find a solid answer that supports your client to make informed decisions and have confident discussions with their healthcare team. [/vc_column_text][vc_column_text css=”.vc_custom_1645285674079{margin-bottom: 0px !important;}”]My approach to research draws from a mix of my graduate education in health services research, professional experiences in policy and healthcare research and my lived experiences as a Queer, racialized healthcare user. I am very excited to share knowledge and grow with those who can attend![/vc_column_text][vc_btn title=”Register here for our RESEARCH SKILLS FOR BIRTH WORKERS Webinar” color=”mulled-wine” align=”center” link=”url:https%3A%2F%2Fstefanie-techops.wisdmlabs.net%2Ftraining%2Fresearch-skills-for-birth-workers-webinar%2F|||”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1645285701619{margin-bottom: 0px !important;}”]Citations

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M., Lynch, H., Sahm, L., Heffernan, E., O’Keeffe, E., Blake, C., Horgan, F., & Hegarty, J. (2019). Evidence-based practice education for healthcare professions: An expert view. BMJ Evidence-Based Medicine, 24(3), 103–108. https://doi.org/10.1136/bmjebm-2018-111019

Masic, I., Miokovic, M., & Muhamedagic, B. (2008). Evidence Based Medicine – New Approaches and Challenges. Acta Informatica Medica, 16(4), 219–225. https://doi.org/10.5455/aim.2008.16.219-225

Soliday, E., & Smith, S. R. (2017). Teaching University Students About Evidence-Based Perinatal Care: Effects on Learning and Future Care Preferences. The Journal of Perinatal Education, 26(3), 144–153. https://doi.org/10.1891/1058-1243.26.3.144[/vc_column_text][/vc_column][/vc_row]