New York Coalition for Doula Access

Transcription

New York Coalition for Doula Access
c/o Choices in Childbirth ! 441 Lexington Ave, 19 ! New York, NY ! 10017
E-Mail: DoulasForAll@gmail.com
October 31, 2011
New York State Medicaid Funding for Doula Support
We, the undersigned, represent a coalition of organizations that collectively share a commitment to
ensure that all women have access to high-quality childbirth options that are both safe and satisfying.
Today, we join together to voice our support of Medicaid funding for doula care in New York State.
As you are aware, Governor Cuomo has charged the Medicaid Redesign Team with improving health
outcomes and controlling costs. What you might not know is that doula support does both. A doula
is a woman specifically trained to provide continuous physical, informational, and emotional support
to pregnant women during the process of childbirth. Having the constant support of a doula by a
laboring woman’s side has been shown to improve birth outcomes, control costs, and reduce health
disparities.1
For instance, one of the most common surgical procedures in the country is the Cesarean section,
which can be physically stressful and even dangerous for women who undergo it.2 Some 34% of
births end in a C-section3, and rates are highest among African-American women. In 2008, almost
34% of births in New York State were by Cesarean, up from 23% in 1996. 4 Rightly, the Redesign
Team’s first progress report sets a goal of lowering the rate of Cesarean section among Medicaid
patients. Expanded access to doula care will help achieve this goal.5 In fact, research shows that
women who have a doula attend their birth are 21% less likely to have a Cesarean section.6 Since a Csection costs New York Medicaid $5,602 more than a vaginal birth in hospital charges alone ($14,198
versus $8,596 in 2009)7, the savings to the state are potentially enormous:
Number of
births in
NY per
year
Percent of
NY births
covered by
Medicaid
Number of
births
covered
by
Medicaid
Cesarean
section
rate in
New York
State
Estimated
number of
Medicaidcovered
Cesarean
sections in
NY
Percent of
Cesarean
sections
prevented
with doula
support
Number of
cesarean
sections
preventable
through
doula
utilization
Difference in
hospital
charges
between
Cesarean
section and
vaginal birth
249,6558
47%9
117,08810
34%11
39,810
21%
8,360
$5,602
Resulting
savings to
New York
State
Medicaid
$46,832,720
Choices in Childbirth ! Amnesty International USA ! Birth Arts International ! Birth Options Alliance ! BirthNet New York ! Bronx Health Link ! Brooklyn Birthing Center !
Brooklyn Community Services ! Buffalo Birth Network ! CAMBA, Inc. ! Caribbean Women’s Health Association ! CAPPA ! Childbirth Connection ! Childbirth Education
Association of Metropolitan New York ! Coalition for Improving Maternity Services ! Coalition for the Homeless ! Commission on the Public’s Health System ! Community
Cradle ! CONNECT NYC ! DONA International ! Doulas of the Hudson Valley ! Every Mother Counts ! HealthConnect One ! International Academy of Baby Planner
Professionals ! International Center for Traditional Childbearing ! Inwood House ! Lamaze International ! Long Island Doula Association ! Maternal-Infant Services
Network ! Midwives Alliance of North America ! Metropolitan Doula Group ! NARAL Pro-Choice Network ! National Advocates for Pregnant Women ! New York
Homebirth Midwives ! New York Lactation Consultant Association ! New York Statewide Breastfeeding Coalition ! New Yorkers for Accessible Health Coverage ! North
American Registry of Midwives ! Northern Manhattan Perinatal Partnership ! Orange County Doulas ! Rochester Area Birth Network
1
Doula care is also associated with decreased use of epidural anesthesia12, which would save New York about
$1,000 per birth13 -- and other medical interventions.14 Of course, the state would have to pay the doulas, but
there would also be savings from physicians’ fees not incurred for Cesarean surgeries, from other avoided
medical interventions, and from improved health for both mother and baby.
Given that doulas have no medical training and provide no medical support, you might wonder how doulas
can make such an impressive difference in a woman’s medical outcome. By “mothering the mother,” doulas
help reduce stress in a laboring woman. In a hospital environment that is often chaotic and impersonal,
especially for women of low socioeconomic status, the continuous presence of a caring, supportive doula is
often the only positive reinforcement that a laboring woman will experience. Having someone by your side
who believes in you, trusts that you are capable of birthing your child, and stays with you for every step of
your labor is often all a woman needs in order to find her strength and birth her child without the aid of costly
medical interventions. Ample research shows that the continuous presence of a caring, calming, and
supportive doula not only leads to a more empowering and rewarding birth experience, but also to a host of
other improved birth outcomes, such as:
-
increased initiation and duration of breastfeeding15
shorter labors16
less need for anesthesia or analgesia17
fewer vacuum and/or forceps births18
higher APGAR scores19
better mother-baby bonding20
less postpartum depression21
more positive feelings about the birth22
These outcomes, in turn, lead to many other health improvements. Breastfeeding, for instance, decreases a
child’s risk of overweight and obesity, childhood illnesses, SIDS, asthma, and diabetes.23 It also helps the
mother lose weight gained during pregnancy—important because 52% of U.S. women of childbearing age are
overweight24—and decreases her risk of postpartum depression, diabetes, heart disease, and various cancers.25
Women and families around the country are recognizing the benefits of doula care, as is reflected in the
increasing number of doula-attended births in the United States. To read supportive comments by women
who benefited from a doula, by health-care providers, and by doulas themselves, please see our petition at
http://www.thepetitionsite.com/1/doulas-for-all/. Unfortunately, access to this support is reserved almost
exclusively for families who can pay out of pocket for a doula’s services. The few organizations that provide
free or low-cost doula care are dwarfed by the need.
2
We believe that every woman should have access to doula care and the health benefits associated with that
care, regardless of her income. Researchers from the respected Cochrane Collaboration agree. As they stated in
Cochrane's 4th systematic review of "continuous support" such as that provided by doulas, "Given the clear
benefits and absence of adverse effects of continuous labour support, policy makers should consider including
it as a covered service for all women." (February 2011)
At the same time, we recognize that the members of the Redesign Team are charged with the daunting task of
significantly reducing spending while weighing the health care needs of the citizens of our state. Given the
current financial climate, we would not waste your time with this request if this recommendation were not
backed up by substantial medical evidence demonstrating that Medicaid funding for doula care would quickly
provide a significant cost savings to the state.
We strongly urge you to recommend covering doula care and making this exceptional service available to all
birthing women in New York State. The change will be both cost-effective and important to the health and
well-being of all New Yorkers, short- and long-term. Every woman and her family deserve the quality of care
that doulas provide, and New York State taxpayers deserve the cost savings that will result.
Thank you for your consideration.
Élan McAllister, President
Choices in Childbirth
Joshua Rubenstein, Northeast Regional Director
Amnesty International USA
Demetria Clark, Global Director
Birth Arts International
Birth Options Alliance
Carolyn Keefe, CoFounder
BirthNet New York
3
Bronx Health Link
Brooklyn Birthing Center
Barry Newmark, Interim Executive Director
Brooklyn Community Services
Jeanine Moyer, Co-Leader
Buffalo Birth Network
Joanne M. Oplustil, Executive Director
CAMBA, Inc.
Cheryl Hall, Executive Director
Caribbean Women’s Health Association
Tracey Wilson Peters, Chief Executive Officer
Childbirth and Postpartum Professional Association (CAPPA)
Maureen Corry, Executive Director
Childbirth Connection
Tamara Wrenn, Board President
Childbirth Education Association of Metropolitan New York
Michelle Kendall, Interim Chair
Coalition for Improving Maternity Services
Mary Brosnahan, Executive Director
Coalition for the Homeless
Judy Wessler, Director
Commission on the Public’s Health System
4
Lucy Pulitzer, Executive Director
Community Cradle
Kala Ganesh, Executive Director
CONNECT NYC
Jennifer Rokeby- Mayeux, President
DONA International
Doulas of the Hudson Valley
Christy Turlington Burns, Founder
Every Mother Counts
Rachel Abramson, Executive Director
HealthConnect One
Mary Oscategui, Founder and President
International Academy of Baby Planner Professionals
Shafia M. Monroe, President and CEO
International Center for Traditional Childbearing
Linda Lausell Bryant, Executive Director
Inwood House
Linda Harmon, Executive Director & CEO
Lamaze International
Deborah Rotunno, President
Long Island Doula Association
Caren Fairweather, Executive Director
Maternal-Infant Services Network
5
Geradine Simkins, President
Midwives Alliance of North America
Metropolitan Doula Group
Sabrina Shulman, Vice President of Political and Legislative Affairs
NARAL Pro-Choice New York
Lynn Paltrow, Executive Director
National Advocates for Pregnant Women
New York Homebirth Midwives
Susan Burger, President
New York Lactation Consultant Association
New York Statewide Breastfeeding Coalition
Heidi Siegfried, Director of Health Policy
New Yorkers for Accessible Health Coverage
Ida Darragh, Chairperson
North American Registry of Midwives
Mario Drummonds, CEO
Northern Manhattan Perinatal Partnership
Courtney Durfee, Founding Member
Orange County Doulas
Sherri Lauver, President
Rochester Area Birth Network
6
1
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. “Continuous support for women during childbirth.”
Cochrane Database of Systematic Reviews, 2011, Issue 2.
2
Amnesty International. “Deadly Delivery: The Maternal Health Care Crisis in the U.S.” One-year update,
Spring 2011. http://www.amnestyusa.org/pdf/DeadlyDeliveryOneYear.pdf.
3
“HealthGrades Obstetrics and Gynecology in American Hospitals,” 2009 data, page 2.
http://www.healthgrades.com/business/img/HealthGrades2011ObstetricsandGynecologyinAmericanHospi
talsReport.pdf. Accessed September 29, 2011.
4
National Center for Health Statistics, Data Brief. “Recent Trends in Cesarean Delivery in the United States.”
Number 35, March 2010 (2007 data). http://www.cdc.gov/nchs/data/databriefs/db35.htm.
5
Trueba G, Contreras C, Velazco M, Lara E, Martinez H. “Alternative strategy to decrease cesarean section:
support by doulas during labor.” J Perinat Educ, 9:1-6, 2000.
6
Hodnett, Gates, Hofmeyr, Sakala, Weston. Page 11, Cesarean outcome: relative risk with a doula is 0.79.
7
U.S. Dept. of Health and Human Services, http://hcupnet.ahrq.gov. Accessed October 4, 2011.
8
New York State Department of Health, http://www.health.state.ny.us/statistics/chac/birth/medslf65.htm.
Accessed April 20, 2011. New York State reported 249,655 births in 2008 (most recent available). Of those,
46.9%, or 117,088 births, were covered by Medicaid. New York City reported 121,756 births, of which 60.1%, or
73,175 births, were covered by Medicaid.
9
Ibid.
10
Ibid.
11
National Center for Health Statistics.
12
Kennell JH, Klaus MH, McGrath SK, Robertson S, Hinkley C. “Continuous emotional support during labor
in a US hospital: a randomized controlled trial,” JAMA, 265:2197- 2201, 1991.
13
Klaus MH, Kennell JH, Robertson SS, Sosa R. “Effects of social support during parturition on maternal and
infant morbidity,” Br Med J, 293:585-587, 1986.
14
Kennell, Klaus, McGrath, Robertson, Hinkley.
15
Nommsen-Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. “Doula care, early
breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae.” J
Obstet Gynecol Neonatal Nurs, 38:157-173, 2009.
16
Campbell DA, Lake MF, Falk M, Backstrand JR. “A Randomized Control Trial of Continuous Support in
Labor by a Lay Doula.” JOGNN, 35 (4): 456-464), 2006.
17
Kennell, Klaus, McGrath, Robertson, Hinkley.
18
Ibid.
7
19
Gordon NP, Walton D, McAdam E, Derman J, Gallitero G, Garrett L. “Effects of providing hospital-based
doulas in health maintenance organization hospitals.” Obstet Gynecol, 93(3):422-426, 1999.
20
Landry SH et al. “The effects of doula support during labor on mother-infant interaction at two months,”
Pediatric Res, 43:13A, 1998.
21
Wolman WL, Chalmers B, Hofmeyr GJ et al. “Post-partum depression and companionship in the clinical
birth environment: A randomized, controlled study.” Am J Obstet and Gynec, 168: 1380-1393, 1993.
22
Gordon, Walton, McAdam, Derman, Gallitero, Garrett.
23
WomensHealth.gov, http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-important/.
Accessed April 20, 2011.
24
Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TIA, Rasmussen KM. “Breastfeeding reduces postpartum
weight retention.” American Journal of Clinical Nutrition; 2008; vol 88: pp 1543-1551.
25
WomensHealth.gov. The cancers are breast cancer and ovarian cancer.
8
The following organizations stand united in support of
New York State Medicaid Funding for Doula Support
Buffalo Birth
Network
*cphs
*Putting the public
back in public health.
Community Cradle
DOULAS
OF THE
HUDSON VALLEY
Maternal-Infant Services Network
of Orange, Sullivan, & Ulster Counties
New York
Statewide
Breastfeeding
Coalition
New Yorkers for Accessible Health Coverage
FiXe^\
:flekp
;flcXj
Rochester Area
Birth Network

New York Coalition for Doula Access

Transcription

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