This document provides an overview of a new initiative to improve shared decision making in maternity care. It will develop a comprehensive set of decision tools including a decision aid, multimedia content, and ways to influence factors driving medical decisions. Interviews found the top concern was high c-section rates. The tools will help understand elective c-section reasons and birth options like VBAC. The initiative will have an intuitive interface and novel engagement strategies. It is led by a team of experts in content, strategy, production and project management.

1. SNEAK PEEK AT MATERNITY CARE
INITIATIVE
A NOVEL APPROACH TO SHARED DECISION MAKING IN
M AT E R N I T Y C A R E
Molly Beinfeld, MPH
Director, Independent Production
July 2012

2. Comprehensive set of decision tools
2

3. Fresh user interface
3

4. Novel engagement strategies
4

5. 5

6. 6

7. WHAT IS THE MATERNITY CARE SDM
INITIATIVE?
Maternity Care
SDM Initiative
7

8. TOOLS
• What are the opportunities?
• Multi-stakeholder interviews (16)
• #1 concern: C-section rate
8

9. VBAC
C-Section
33%
Vaginal
67%
9

10. 100%
90%
80% Repeat
70%
60%
C-Section 50%
33% 40%
Primary
30%
20%
10%
0%
1
10

11. Elective
Repeat
*Many stated
reasons are not
*Reasons
Primary
supported by
Repeat
high-quality
Primary evidence.
1
11

12. 100% Breech/Transverse
Elective 90% Multiples
Pre-Labor Pre-existing
80%
Conditions
70% Suspected
Macrosomia
60%
*Reasons 50%
Slow Labor Progress
During a bor
L
Pre-­ bor
­L
40%
During Fetal Distress
Labor
30%
20%
10%
0%
1
12

13. Cesarean Births in the U.S.
Opportunities for decision support
100%
90% Breech/Transverse
Elective Multiples
Pre-Labor Pre-existing Conditions
100%
80% Suspected Macrosomia
90%
70%
80% Repeat
VBAC
70% 60%
60%
50% During a bo
L
50% *Reasons
Primary a
Pre-­ bor
­L
Repeat Slow Labor Progress
40% 40%
Primary During Labor Fetal Distress
30%
30% Potential Influnc er s
20% and Drivers
10% 20% Provider/Setting
Labor Induction
0% Labor Interventions
e
1 10%
0%
1
= Decision Aid
* Many stated reasons
= Multimedia Interactive Contente are not supported by
high-quality evidence.
= Influnc er /D iv
r er 13
© 2012 Informed Medical Decisions Foundation and Childbirth Connection

14. SOURCES
• Zhang J, Torendle J, Reddy UM, et al.
Consortium on Safe Labor. Contemporary
cesarean delivery practice in the United
States. Am J Obstet Gynecol. 2010;203:326.e1-
10.
• Barber EL, Lundsberg LS, Belanger K, Pettker
CM, Funai EF, Illuzzi JL. Indications
contributing to the increasing cesarean
delivery rate. Obstet Gynecol. 2011;118:29-38.
14

15. INTERFACE
15

16. CONTENT MANAGEMENT SYSTEM
16

17. ENGAGEMENT
17

18. THE “DREAM TEAM”
Content Strategy and Outreach
Amy Romano, MSN, CNM Maureen Corry, MPH
Carol Sakala, MSPH, PhD Lyn Paget, MPH
Suzanne Brodney, PhD Diana Stilwell, MPH
Jessica Turon
Production
Medical Editor Sherry Reisner
Kathie Hartmann, MD, PhD
Project Management
Carin Upstill
18