The Birth Survey: Transparency in Maternity Care
Location
This project was created to give mothers a loud and resounding voice - via the internet - about their experiences in childbirth. It connects new mothers to the experiences of those who have birthed before them, gives families their rightful access to local hospital practices and health outcomes, and offers providers and institutions the opportunity to improve care by being able to truly “listen to women”. This breakthrough grassroots project has the potential to shift the balance of power in maternity care back into the hands of the consumer – at a time when mothers and babies are experiencing some of the most significant barriers to accessing and receiving evidence-based care ever seen in the U.S.
At the heart of the project is “The Birth Survey” where mothers rate their experiences with pregnancy care providers and institutions. These ratings are then consolidated with specific institutional intervention rates and outcome indicators.
Because institutional outcome indicators are not easily available, the project will also deliver regional trainings throughout the country to grassroots advocacy groups working with state and regional agencies to secure institutional data. Who are the primary beneficiaries? The primary beneficiaries are mothers and their babies. The project is also structured to provide vital consumer feedback to professionals and institutions. How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? Providing this data is vitally important as evidence has shown that mother and infant health outcomes are directly linked to the appropriate utilization of procedures and interventions. We aim to make information accessible while linking it with consumer feedback giving consumers both an unprecedented voice and a choice. This project is unique in that we are focusing exclusively on maternity care and our survey questions are designed to reflect the evidence and the highest standards of maternity care.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Advocacy
Year the initiative began (yyyy)
2006
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Health care not consumer friendly
Which of the principles is the primary focus of your work?
Center consumers in business model
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
The barrier Monopolies of Knowledge and the principle Simplify Through Technologies would also apply to this project. The great majority of obstetrical services in U.S. hospitals monopolize their data on institutional practices and health outcomes, which in any other consumer driven business would be available, forcing mothers and their families to choose ‘blindly” where and with whom they given birth. A common comment is that one usually knows more about their auto shop, than the hospital where they are having their baby. This project will expose the well guarded data that every family deserves to know, using The Birth Survey, the web, and the power of consumers.
Name Your Project
The Birth Survey: Transparency in Maternity Care
Describe Your Idea
This project was created to give mothers a loud and resounding voice - via the internet - about their experiences in childbirth. It connects new mothers to the experiences of those who have birthed before them, gives families their rightful access to local hospital practices and health outcomes, and offers providers and institutions the opportunity to improve care by being able to truly “listen to women”. This breakthrough grassroots project has the potential to shift the balance of power in maternity care back into the hands of the consumer – at a time when mothers and babies are experiencing some of the most significant barriers to accessing and receiving evidence-based care ever seen in the U.S.
At the heart of the project is “The Birth Survey” where mothers rate their experiences with pregnancy care providers and institutions. These ratings are then consolidated with specific institutional intervention rates and outcome indicators.
Because institutional outcome indicators are not easily available, the project will also deliver regional trainings throughout the country to grassroots advocacy groups working with state and regional agencies to secure institutional data. Who are the primary beneficiaries? The primary beneficiaries are mothers and their babies. The project is also structured to provide vital consumer feedback to professionals and institutions. How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? Providing this data is vitally important as evidence has shown that mother and infant health outcomes are directly linked to the appropriate utilization of procedures and interventions. We aim to make information accessible while linking it with consumer feedback giving consumers both an unprecedented voice and a choice. This project is unique in that we are focusing exclusively on maternity care and our survey questions are designed to reflect the evidence and the highest standards of maternity care.
Innovation
Define the innovation
This project was created to give mothers a loud and resounding voice - via the internet - about their experiences in childbirth. It connects new mothers to the experiences of those who have birthed before them, gives families their rightful access to local hospital practices and health outcomes, and offers providers and institutions the opportunity to improve care by being able to truly “listen to women”. This breakthrough grassroots project has the potential to shift the balance of power in maternity care back into the hands of the consumer – at a time when mothers and babies are experiencing some of the most significant barriers to accessing and receiving evidence-based care ever seen in the U.S.
At the heart of the project is “The Birth Survey” where mothers rate their experiences with pregnancy care providers and institutions. These ratings are then consolidated with specific institutional intervention rates and outcome indicators.
Because institutional outcome indicators are not easily available, the project will also deliver regional trainings throughout the country to grassroots advocacy groups working with state and regional agencies to secure institutional data. Who are the primary beneficiaries? The primary beneficiaries are mothers and their babies. The project is also structured to provide vital consumer feedback to professionals and institutions. How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? Providing this data is vitally important as evidence has shown that mother and infant health outcomes are directly linked to the appropriate utilization of procedures and interventions. We aim to make information accessible while linking it with consumer feedback giving consumers both an unprecedented voice and a choice. This project is unique in that we are focusing exclusively on maternity care and our survey questions are designed to reflect the evidence and the highest standards of maternity care.
Context for Disruption:
A growing body of research shows that among the most important factors influencing a woman’s risk of obstetric interventions, especially cesarean surgery, induction of labor and episiotomy, are not just her health status at the time, but where and with whom she gives birth. In short, a woman who goes to a provider or hospital with a high cesarean section rate is more likely to end up with a cesarean section - and to suffer the potential consequences of complications. Research also tells us that facilities and providers with high intervention rates compared with those who intervene less and have a similar kind of client, do not fare any better with respect to healthy outcomes, and often in fact, fare worse. However, in most states, maternity care providers and facilities are not required by law to publicly report intervention rates, nor to help the public interpret data that are available.
How can women make informed choices about their maternity care if they do not have access to the information that is most likely to influence their outcomes? How can a woman decrease her exposure to injury from injudicious use of interventions if she can’t compare rates of interventions of various providers and facilities? Transparency is providing health care consumers with the information they need – and the means to interpret it – in order to evaluate the quality of care provided by individual providers and institutions.
Health care agencies are getting the message. There is a trend toward more transparency and public reporting, however maternity care has thus far been left out of the mix. This is true despite the fact that maternity care represents a large proportion of health care expenditures and the overuse of interventions contributes to excess risk of injury to women and babies and to excess costs. Our project links traditional “transparency” with consumer feedback so that consumers can have both a seat at the table and a more robust picture of their maternity care options.
This is a “ground up” transformation project. It is a “vote with your feet” project. Whether women change providers as a result of their interface with the information, change their insurance company during open enrollment, or in some other way, demonstrate their right to choose – their choice will be heard “upstairs” in the healthcare hierarchy. In addition, the publication of consumer ratings, practices and intervention rates have been shown to alter healthcare practice in and of themselves.
Delivery Model
How does your innovation reach its target populations?
The target populations will reach our project through the site TheBirthSurvey.com which has the following features:
o SHARE: The Birth Survey: created for mothers to provide feedback about their pregnancy care and birth experience specific to the particular practitioner and birth environment that served them.
o CONNECT: Transparency Reports: Compiled information about providers and institutions from mother’s experiences in The Birth Survey data will be made available online once a defined threshold of responses has been collected. Site users can search by provider or institution on specific measures.
o LEARN: Institution-level Intervention Rates: Where available, these statistics will also be available on the website. Site users such as expectant mothers, policy makers, advocates, and providers may search by state and receive reports which compare intervention rates for up to three institutions at a time. The Birth Survey responses may then be paired with the official state statistics to further help expectant women make informed decisions about where and with whom to give birth.
What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place?
New York City is the pilot city for the project where we are working with multiple community organizations. Due to launch on national basis in 2008, we are working with a network of childbirth consumer groups throughout the country who will serve as “host” cities for the national launch. Viral marketing, word of mouth, and local grassroots organizations will be used to alert mothers of the site’s availability. In addition, provider and institutional lists are being obtained from professional organizations and agencies.
What is your current market penetration? How do you measure this?
The Birth Survey goes officially live for the first time July 21st, 2007.
Key Operational Partnerships
Transparency in Maternity Care is a project of the Coalition for Improving Maternity Services (CIMS). As such, it is partnered with multiple national childbirth organizations, individual professionals and consumer advocates throughout the country. Initial support for the project has come in from Lamaze International, Birth Network National, Citizens for Midwifery, and the American College of Nurse Midwives. The project’s conception was the result of a national gathering of over 50 women in 2006, many of whom remain active in the project today and/or who will become active when the survey is available in their community.
Since New York City is the pilot site, a strong partnership has been established with the local advocacy group Choices in Childbirth, who recently received a national award for their work with the City of New York Public Defender's Office to ensure that women have access to the materity care data that should be made available to the public under the Maternity Information Act in New York.
Partnerships such as these with local advocacy groups and consumer agencies are critical to the success of the project. This is why providing training for grassroots organizations throughout the country is a core feature of the project.
Impact
Financial Model
The financial model for the project itself does not involve earned income. However, this is a project of the Coalition for Improving Maternity Services and is therefore a subset of a larger financial model as well. Within that model earned income is currently generated from our annual CIMS Mother Friendly Childbirth Forum and to a small amount, product sales. Beginning in 2008 Coalition membership fees will begin and product sales will increase with the release of two publications, At this time, approximately 25% comes from earned income at CIMS.
What is your annual operating budget?
$59500 (project)
What are your current sources of revenue? (please list any sources that are foundation grants)
PROJECT EXPENSES
Personnel
Project Director .25 FTE @ $72K/Yr* 18,000
Administration Services .25 FTE @ $36K/Yr.* 9,000
Consultants
Legal Fees 3,000
Database/Website Maintenance @ $500/Mo.* 6,000
Marketing, Promotion
Attendance at National Conferences 4,000
Includes travel, handouts, booth space
Marketing Website 5,000
Advocacy Outreach & Training
Grassroots Advocates Training 4,500
Includes travel, training materials
Webcasts for Grassroots Advocates 1,500
Website Costs
Hardware 1,000
Website Host 500
Provider/Membership List Aquisition 5,000
Office Expenses
Phone, Copying, Fax Charges 600
Office Supplies 600
Printing, Copying 800
TOTAL EXPENSES 59,500
PROJECT INCOME
Contributions:
Organizations: 5,000
Individuals: 4,000
"Give Meaning" Donations 3,000
Grants
Challenge Grant 5,000
Program Grants** 35,000
Foundations 5,000
Other Foundations 2,500
TOTAL INCOME:
TOTAL: 59,500
*includes benefits and office overhead
Effectiveness
Since The Birth Survey is yet to premiere at the time of this submission, its impact remains to be seen. However, the impact of its context, the Mother Friendly Childbirth Initiative is clear. Created in 1986 as the country’s first consensus initiative on the care of women in pregnancy and birth, CIMS is comprised of consumers, grassroots activists, professionals and organizations committed to this model of care as defined in the Mother-Friendly Childbirth Initiative (MFCI). In the 11 years following the creation of the MFCI, its impact and spread throughout the world has been a testimony to the power of grassroots advocacy. Today CIMS has been recognized by the United Nations as an NGO, the MFCI has been translated into 8 different languages and is being used actively to transform maternity care in 17 (known) countries. With the recent publication of the Evidence Basis for the Ten Steps Mother-Friendly Care in the Journal of Perinatal Education (March 2007) CIMS has provided the midwifery and maternal-child health community with critical new research that delivers a new foundation of support for those who provide and stand for Mother-Friendly Care.
In the Fall of 2006, the International Committee of CIMS evolved into a new NGO, the International MotherBaby Organization now working closely with WHO and UNICEF and a host of international childbirth organizations to develop an International MotherBaby Childbirth Initiative that defines ten steps of care for the humane, safe and evidence-based treatment of mothers throughout the world.
Which element of the program proved itself most effective?
In the spring of 2007, we developed a mini-survey to get a better understanding of what women ultimately wanted to learn from the Birth Survey. The mini survey was made available online for a period of two weeks. We received just over 1100 completed surveys. Based on this experience gained in the testing phase, it appears that mothers want very much to share their experiences such that the demand for the website will be sufficient to provide the survey data needed to establish an adequate supply of information for communities and families.
Also, unlike other “rate your doctor” type websites, all the questions in The Birth Survey are oriented to mother friendly care so that they are going to provide information specific to practices proven to impact healthy outcomes, for instance: “During prenatal appointments, did your midwife discuss with you your options for pain control during your labor and delivery?” and “In the hospital, while you were experiencing regular and well-established contractions, were you free to walk around if you wanted to?”
Number of clients in the last year?
Because the pilot will be launched in New York City on July 21, 2007, we will not have information about numbers of completed surveys or number of visits to the website until the end of the project's first quarter.
What is the potential demand?
Over 4 million women give birth in the United States each year, if just 1% of them connect with The Birth Survey each year, that would set up a database of 40,000 births. In addition, based on our experience with the Mother Friendly Childbirth Initiative, while this has been designed as a U.S. project, we fully expect it to be in demand on an international basis and will work to meet that demand as it arises.
Scaling up Strategy
The project is planned in three phases:
Phase I - July 07-June 08:
The Birth Survey and website will go online during this pilot phase in New York City. At this time, grassroots activists and organizations throughout the country will also be recruited for Phase II sites.
Phase II: July 08-June 09:
The Birth Survey will be made available to consumers in ten additional markets.
Phase III:
The Birth Survey will be made available to consumers in at least 20 additional markets.
Stage of the initiative:
0
Expansion plan:
While we will be learning from this pilot year and making improvements along the way, strategic planning is underway for phase two of the project when we expect to make the website available to consumers of maternity care in ten additional markets. This planning process includes training of grassroots activists, technology, marketing, and financial components. Additionally, our planning includes tactics to create collaborations with health care quality improvement organizations and coalitions as well as other websites working to provide consumers with health care quality information.
Origin of the Initiative
Maternity care in the US has historically been impacted by consumer advocacy. In the last decade, hundreds of grassroots community organizations have been formed to help women become better informed consumers of maternity care. For the most part, these organizations operate very independently of one another and there exists no mutual agenda for making change. A small group of women came together at a CIMS annual forum and began planning for a way that grassroots organizations around the country can come together and work towards accomplishing a mutual goal. Successful grassroots movements have been able to develop this common agenda and to inspire individuals and organizations to come together around this agenda. The Birth Survey is intended to do just this.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
The first is that, at this time, our organization is entirely run by volunteers. Being able to sustain the growth of this initiative as it becomes a national initiative will require a stable central organization. We are in the process of seeking core funding for a central office and an administrative staff to help us meet the demands of our national consumer base. This base has grown exponentially with the recent publication of our large research project and we anticipate it to grow even further when The Birth Survey goes live. Our second challenge has been that we have been almost entirely reliant on contributions, grants and gifts. We are involved now in strategic planning to develop a product line for consumers and professionals. However, we need the centralized office and administrative staff to support that.
How did you hear about this contest and what is your main incentive to participate?
We heard about this as we were preparing to apply to the Pioneer Grant Portfolio at the Robert Wood Johnson Foundation. It seemed to be a perfect match for the nature of our project and we are eager to share our project idea with others working to reform health care in the US.
The Story
Do you have an annual financial statement?
Yes
Do you currently have an annual financial statement that tracks profit/loss?
Yes
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
The majority of the project funding in year one and two will come from foundations. By year five, when the model has been successfully demonstrated, we anticipate this project being supported financially by the organizational and individual supporters of the Coalition for Improving Maternity Services.
 | willowtreephoto said: I am Tori Caswell, and have been through the Birth Survey's ambassador training courses, and have also given birth. Birth is an ... about this Competition Entry. - 1044 days ago read more > |
| donnamomma said: The Birth Survey could be an invaluable tool in closing the gap between what we know is best care for women and what is actually done ... about this Competition Entry. - 1044 days ago read more > |
Comments
The Birth Survey could be an invaluable tool in closing the gap between what we know is best care for women and what is actually done to women. If knowledge is power, then collecting and disseminating information provided by women and health care facilities would be a strong tool in achieving better health care for women. Many other posters have commented on the facts regarding disparities in care, so I will only say that I agree with what has already been said. Please know that the Birth Survey needs to be supported and encouraged. I urge you to consider its importance and value to women. Thank you.
I am Tori Caswell, and have been through the Birth Survey's ambassador training courses, and have also given birth.
Birth is an evolving idea for everyone. For many people it's the farthest thing from their mind one day and 9 months away the next.
Families need an easy, efficent and confidential way to learn about different caregivers and facilities in their area. Word of mouth is currently the ONLY way to learn about these things, and this is not enough.
The importance of the birth experience is often overlooked. Starting at the moment when a woman discovers she is with child, her mind and body go through amazing changes preparing her to care for her child. When any parts of this experience are negative or leave the mother feeling defeated or incapable it affects many other parts of mothering including breastfeeding.
No one kind of care is right for all mothers, this is why the many aspects of feedback on The Birth Survey are so important.
Bottom line, Health Care is a business. Midwives and Doctors are hired by Expectant Parents. The Birth Survey Website empowers familes to hire caregivers that will work for them. Promoting accountability on all sides of the transaction and reducing suites filed and women left feeling unempowered by their entrance to motherhood.
Thank you for reading.
Tori Caswell