MCH Alert


Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.


March 9, 2007

1. Paper Discusses Health Plan Approaches to Address Child Health Disparities
2. Survey Compiles Information on Child Nutrition and Physical Activity Programs
3. Journal Supplement Documents History and Evidence Base for Normal Birth
4. Analysis of Vital Statistics Data Highlights Disparities in Fetal and Perinatal Mortality
5. Authors Compare Maternal Outcomes Associated with Planned Cesarean and Planned Vaginal Births

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1. PAPER DISCUSSES HEALTH PLAN APPROACHES TO ADDRESS CHILD HEALTH DISPARITIES

Reducing Health Disparities Among Children: Strategies And Programs reviews what is known about health disparities among children and explores strategies for addressing these disparities. The issue paper, produced by the National Institute for Health Care Management Foundation, provides a brief overview of health disparities, including the importance of health insurance to address them, as well as its limitation in doing so. The overview is followed by a description of innovative approaches (data collection, provider education, treatment and prevention, community focused) by health plans to reduce disparities and ensure cultural competence. A framework of factors affecting health and well-being; data on the self-reported health status of children by income and parental education level, average annual physician visits among children by health status, percentage of children ever told that they had asthma, and percentage of children who are overweight; and a list of selected resources on maternal and child health disparities are included. The paper is intended to inform policymakers, health professionals, families, and others about the roots of health disparities and the current state of health disparities among children. The paper is available at http://www.nihcm.org/finalweb/HealthDisparitiesFinal.pdf.

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2. SURVEY COMPILES INFORMATION ON CHILD NUTRITION AND PHYSICAL ACTIVITY PROGRAMS

The Shaping America's Youth (SAY) Survey collects information about populations, methods, funding, and outcomes from organizations and programs working in areas related to childhood overweight. The online survey is part of the SAY national cross-sector initiative directed at improving nutrition and exercise in America's children. Survey information is made available in a searchable national program registry on the SAY Web site. The SAY survey and registry are intended for use by health professionals and others in identifying best practices and promoting a common dialogue to address overweight, poor nutrition, and physical inactivity in children. The survey, program registry, and an array of other childhood overweight and obesity information and resources are available at http://www.shapingamericasyouth.org.

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3. JOURNAL SUPPLEMENT DOCUMENTS HISTORY AND EVIDENCE BASE FOR NORMAL BIRTH

The Winter 2007 supplement to the Journal of Perinatal Education describes the history of the Coalition for Improving Maternity Services as part of a global effort to promote "normal birth" (as established by universal guidelines for the routine care of women during uncomplicated labor and childbirth). The supplement presents the principles underlying the Mother-Friendly Childbirth Initiative (MFCI), the first consensus declaration in the history of North America in which a multidisciplinary body of professional organizations and individuals address the issues of labor and birth. The supplement also identifies the Ten Steps of Mother-Friendly Care that lay out the practical application of the philosophy and principles of the MFCI and introduce the evidence base for the Ten Steps. Discussion and commentary are provided. The supplement is intended for use by health professionals, families, and others in supporting normal birth and breastfeeding as the standard of care for all women. The supplement is available to journal subscribers at http://www.ingentaconnect.com/content/lamaze/jpe.

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4. ANALYSIS OF VITAL STATISTICS DATA HIGHLIGHTS DISPARITIES IN FETAL AND PERINATAL MORTALITY

Fetal and Perinatal Mortality, United States, 2003 presents detailed data on fetal and perinatal deaths and mortality rates for the United States for 2003. For the purposes of the report, published by the National Center for Health Statistics, fetal mortality refers to the intrauterine death of a fetus at any gestational age, and perinatal mortality refers to death around the time of delivery and includes both fetal deaths (at least 20 weeks of gestation) and early infant (neonatal) deaths. The authors examine data from the 2003 fetal death data file and the 2003 period linked birth and infant death data file by a variety of characteristics, including race and Hispanic origin, maternal age, marital status, sex of fetus, plurality (multiple deliveries), birthweight, and period of gestation. Fetal and perinatal mortality rates by state are provided. A discussion, references, a list of detailed tables, and technical notes are also included. The report is available at http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf.

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5. AUTHORS COMPARE MATERNAL OUTCOMES ASSOCIATED WITH PLANNED CESAREAN AND PLANNED VAGINAL BIRTHS

Our study found "a small, but consistent growth in planned primary cesareans, but higher costs, longer hospital stays, and substantially greater risks of maternal rehospitalization associated with these deliveries," state the authors of an article published in the March 2007 issue of Obstetrics and Gynecology. The March 2006 National Institutes of Health (NIH) State-of-the-Science Conference report concluded that there was a need for research that explicitly compared outcomes of planned cesarean delivery with outcomes of planned vaginal delivery. The article examines 6 years of data from a population-based linked data system to create a refined measure identifying women with planned cesareans and planned vaginal births and comparing maternal outcomes and costs associated with these two options.

Data for the analyses were drawn from the Pregnancy to Early Life Longitudinal Data System, a public-private partnership among Boston University's School of Public Health, the Massachusetts Department of Public Health, and the Centers for Disease Control and Prevention. Birth certificates were linked to the infant's hospital discharge records for the birth event, and birth and fetal death certificate records were linked to the mother's delivery record. Subsequent maternal hospitalizations were identified by linking birth-event data longitudinally to maternal hospitalizations in Massachusetts hospitals in the year after the birth. Cases in which a woman gave birth a second time within a year of the index birth were excluded. The study sample included women who had not had a prior cesarean birth and who had a singleton, full term birth, with "no documented prior risk." Women were classified, in conformance with NIH-recommended guidelines, as planned cesarean births (primary cesareans with no labor and no documented complications; N=3,334) or planned vaginal births (vaginal or cesarean births with labor). The planned vaginal group consisted of vaginal births with no documented labor complications (N=172,329), vaginal births with documented labor complications (N=47,509), and primary cesarean births with documented labor complications (N=20,916). The analyses examined rates of maternal hospital re-admission to any Massachusetts hospital, as well as unadjusted and adjusted odds rations for re-admission, during three time periods after discharge for the birth: 1-30 days, 31-180 days, and 181-365 days. Costs of initial and subsequent hospitalizations were also calculated, including average costs by method of delivery controlling for age, parity, race or ethnicity, and payer source. Women's length of hospital stay was also examined.

The authors found that
"Our findings suggest that planned primary cesareans are not without immediate health consequences for mothers and financial implications for society," state the authors. They conclude that "clinicians should be aware of the increased risk for maternal rehospitalization after cesarean deliveries to low-risk mothers when counseling women about their choices."

Declercq E, Barger M, Cabral HJ, et al. 2007. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetrics and Gynecology 109(3):669-677. Abstract available at http://www.greenjournal.org/cgi/content/abstract/109/3/669?etoc.

Readers: More information is available from the MCH Library's knowledge path, Preconception Care and Pregnancy, at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html; from the bibliography, Prenatal Care, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_prenatal.html&-MaxRecords=all&-DoScript=auto_search_prenatal&-search; and from the organizations resource lists, Maternal Morbidity and Mortality, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_matmort.html&-MaxRecords=all&-DoScript=auto_search_matmort&-search and Prenatal Care, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_prenat.html&-MaxRecords=all&-DoScript=auto_search_prenat&-search.

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MCH Alert © 1998-2006 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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