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Join us as we dive deeper into the rising severe maternal morbidity and maternal mortality rates in the United States through a data-driven, quality improvement lens. Each episode will foster discussion with those committed to improving maternal health outcomes and saving lives.
Christie - 00:00:05:
Welcome to AIM For Safer Birth. I'm your host, Christie Allen, the Senior Director of Quality Improvement and Programs at the American College of Obstetricians and Gynecologists, or ACOG. On this podcast, we dive deeper into the rising severe maternal morbidity and maternal mortality rates in the United States through a data-driven quality improvement lens. In this season, we are taking some time to talk with maternal health innovators about charting a course for high-quality rural maternity care. And I'm excited to talk with Amy Romano. Amy is the Founder and CEO of Primary Maternity Care, a service design and consulting firm that helps health systems and other stakeholders improve maternity care. A nationally recognized expert in maternity care improvement and innovation, Amy has dedicated her career to revolutionizing maternity care practices and spearheading a nationwide campaign for more compassionate, evidence-driven care for everyone. Thanks for joining me, Amy.
Amy - 00:00:57:
Thank you, Christie. I'm so excited to be here and to be talking to the ACOG community about rural health.
Christie - 00:01:04:
To begin with, as I'm reading and looking at your information and your bio, I see some credentials after your name. And I see MBA, MSN, CNM. So I know that you have a master's in business as well as being a nurse midwife. And that's a little bit of an unusual combination. Can you talk to me a little bit about how that happened and why?
Amy - 00:01:25:
Sure. I'm hoping there will be more of us because I think it's a really awesome combination. I like to say that I'm midwifing the system and it's sort of through the combination of my clinical background and practice and working at the system level, including working and now using that MBA. So yeah, I became a midwife first, but even before I was a midwife, I was working in public health communications and already had this kind of system view. And then when I came out of midwifery school and was sitting for my boards, I also was like nine months pregnant. And so I was going through the process of becoming a mom myself and being a consumer of maternal health services. So I was, and also trying to sort of figure out the hustle and side hustle of balancing early motherhood with, you know, the new career and all of that. So I kind of stepped into a birth center job right out of midwifery school and also was doing some consulting work for Lamaze International, which of course is a national childbirth education organization. And that work was kind of drawing on my previous public health work that I had done. And that included work in the global health arena. So like I had only a little bit, it was early career stuff, but I was really grounded in some work in like Guatemala and Uganda, where there just really is community birth happening. And then I went into community birthing in the United States and into childbirth education, which is another kind of just community model and sort of patient and family focused model. And so, and then I was like becoming a mom. So I was just like from the beginning, looking at the whole thing through a system lens and intending to kind of bring the public health threads into the work that I did. And then I had the opportunity, I worked clinically for about five years full time. And then I transitioned into more of the kind of work I had been doing with Lamaze. And I was working first with Lamaze and then Childbirth Connection. And that was at the time that they had their transforming maternity care partnership. And there are a lot of stakeholders. ACOG was one of them looking at the kind of, again, the whole system view. And so I was working in that role in a nonprofit and. And they're now part of the National Partnership for Women and Families, but it was an independent nonprofit. And we kind of knew we were going to go in one or more different directions as far as the organization changing. And so we were doing a lot of just inventory work. And I was, I had reached the point in my career where I could like tell you all the things that needed to change, but I was terrified of somebody actually asking me to change those things, you know, like go do the work, here's money, go do it. And I was like, I don't know how the money really works in the system. I don't know how power really works because I'm a midwife and we don't have much of that. So I really was just like, I need a set of skills. And I had always seen myself going back for public health school. And I still love public health, but still never gotten any more training in public health, but I went and got an MBA in healthcare leadership at Yale, which was a great program. And then, yeah, I mean, we can talk about it, but like really shifted into some really dynamic work after that, that drew on the clinical work as well as the system stuff, but then was in kind of the startup space for a while.
Christie - 00:05:03:
I really want to dive into that and hear a little more about that. That's one of the reasons we're talking today. It sounds like you're a very immersive learner, even going so far as to give birth while you're learning and parenting. It is really unique to get to experience the system from almost all sides as you move through it, even when we know that our experiences may not be translatable to other marginalized populations, but to really understand the way the system doesn't even serve those of us with a ton of privilege. It's a very unique experience, I think.
Amy - 00:05:37:
Yeah, absolutely. And it's also, we know physiologically, it's changing your brain. So I was just learning midwifery while my brain was becoming reorganized for motherhood. And I just find it, I found it also fascinating. And I found it really troubling how hard it still was for me with all of the knowledge that I had to get the birth that I envisioned and not have to like make major trade-offs. And I was planning a home birth and I was a home birth midwife for part of that. And I worked in a hospital that was a five-minute walk from my house. So I knew I had a safety net and I, you know, but I was just like, you know, you still become an outsider when you make that choice. And so I was doing, navigating all of that and really digging into the research to try to understand it myself and explain it to other people. And yeah, it was a real, I'm so glad, I feel like, it's not necessarily how I planned it, but I really shaped how I went into my career. And then it kind of also just like forced me to kind of take on some side jobs that ended up being really valuable for kind of being able to not just have a clinical lens, but have other lenses as well.
Christie - 00:06:53:
So I want to, speaking of those career shifts and lens, to begin with, can you go into a little more detail about, I mentioned that you're the CEO of Primary Maternity Care. Can you talk to us a little bit about sort of the mission and vision there as we start aligning this with some of our rural maternity care talk I know we're going to have today?
Amy - 00:07:13:
Yeah, well, I think of like primary maternity care, lowercase. I mean, I named my company that, but I was stewing on that concept ever since it was introduced to me by my colleague, Carol Sakala, from my previous role at Childbirth Connection. And I just connect again with having done some global work and thought about other global systems, there's this concept that maternity care is primary care and it's rooted in communities and it, you know, like so many other models are rooted on like first you see a midwife and then when things get complicated, that's when the physicians get involved. And there's just this concept of a first level of care that has been missing from the United States. So as I went through my very circuitous career, I was touching all these different parts of the system, but always from the perspective of community-based care models and first level care and midwifery models and home birth and birth centers and that kind of stuff. So I started doing some consulting right before the pandemic started. And then the pandemic started and it really ramped up the interest in community-based care models. And one of my first projects was to help a number of other partners open up a pandemic birth center in the first wave of the pandemic in New York City.So when people were absolutely unsure if it was even safe to go into hospitals and there was this huge surge in interest for out-of-hospital birth and there was this sudden easing of all the regulatory hurdles and we were able to open a birth center in six weeks in New York City during a pandemic and have it staffed with people who had run drills and had a process that was on paper of how to transfer the patient into the hospital and had supplies and equipment. And it was in a hostel in Midtown. So it was pretty remarkable what you can do when everyone's swimming in the same direction and the regulatory hurdles have all gone away and there's urgency and stuff like that. So I just started my company because I needed a company to get the, start getting the work done. And that concept of we need to rebuild this system. And so much of the emphasis has been on the hospitals and optimizing for the most complicated cases. And we need that for the people that have a credo and twins and all the things. But we also need every community to have some level of preparedness for pregnancy and birth and postpartum because there are people everywhere. There's people, there's people who've given birth or who are going to. And so what is the level of care that is needed there? Is it a tertiary care center in every community?
Christie - 00:10:07:
Yeah, I hear you talking, as you're discussing sort of through the thread of this, the pressure cooker that allowed us to work and dismantle the typical systems to make a better one in the interim or a safer one than what we were facing at the time. And it feels a little, at this moment, like rural maternity care is another pressure cooker. It is unfortunate that sometimes we need that sort of motivation or even some of the negatives. Please don't misunderstand. I'm not saying COVID was a positive on any level, but we need almost the impetus to make that change. And so we share your goal here at AIM and at ACOG about safe birth in the appropriate place for every person giving birth. So I think that's a nice segue into during the season and in other episodes, we are discussing rural maternity care. What that means, where it is? People seeking care in their own communities. And so one of the reasons I was so interested when I met you recently and heard you talking was about sort of innovative ways you've done some of this quality improvement and safety work for community-based birth, not because it wasn't safe, but because it requires unique quality improvement and unique challenges that I actually am also hearing echoes of in some of the rural maternity care settings, whether that is a level one hospital who is having low risk, which we all know is a little bit of a misnomer because risk can fluctuate, but risk-appropriate care. And then also even hospitals without obstetric services or maternity services that are encountering people giving birth, as well as obstetric emergencies. There's a lot of talk about this and a lot of focus. And I want to talk about the actionable strategies and the pieces that you've seen that have really improved that. That might be of interest to our listeners, whether folks that are implementing bundles or in rural settings or just are interested in what can be done that's actionable, not just we've identified the problem. We have thoroughly identified the problem, but now what are our solutions? So I'd love to hear a little more about that. I'm not sure where you want to start, but I defer to you.
Amy - 00:12:14:
I think, you know, so I live in Connecticut and that's also where I practiced. And we have new birth center regulations here. They're like very outdated. And the governor just made it a big thing to update them and do some other really important maternal health legislation. And a lot of that has been motivated by closures of hospitals in parts of our state. So even here in Connecticut, with all the resources that we have, we have maternity deserts forming for sure. And we have like this kind of this one corridor that's served with hospitals and nowhere else has really good access. So they're trying to solve for that. And they're interested in birth centers. And I'm seeing that more and more that's like, well, maybe birth centers can fix this. And so I want to speak specifically to some of the work that we're doing with birth centers, because I do see a role for birth centers to be part of the solution. But I think we need to like break the mold a little bit of birth centers and really look at some birth centers that are in rural areas. I mean, there are rural states like Alaska and Utah. Some of these states have. Like a lot of birth centers, but they're really. Little bitty like kind of community. They're not big, like, I don't know what people envision when they're envisioning birth centers, but I'll tell you, like, if you've seen one, you've seen one, and there's like birth centers for every type of community. And there's some that are serving, you know, religious enclave communities. And there are some that are serving just like islands that don't have any like hospital on them. And they have, so there are like lots of different versions and we should look at what is out there, but there's also like lots of possibilities that I don't think have been tried. And some of that is because of regulatory hurdles and just... Consumer, you know, preferences, birth centers are places and home birth, you know, the same is true. Where you're not doing epidurals, you're not doing a lot of things that people either want or need. And so it's not for everybody, but it is a level of care that some people are specifically seeking out and that a lot of people, if they have the right information and support could, you know, could access or, and then the other thing that's important is that there are locations for all kinds of care. Like we're all arguing about like whether birth can take place in them, but there's so much other stuff that. A facility that's equipped with 24-7 midwifery, you know, professional midwifery care and a, you know, system for engaging physicians and hospital partners and, you know, transport that's already been like thought through, like that is a facility that's ready to do a lot of stuff besides low-risk birth that you could do. You know, IV hydration, you could work up, you know, especially if you could add like teleconsultation or telehealth components, you could really work up a lot of stuff. And when you look at the literature of what, you know, shows up in the ER, for instance, prenatally or postpartum. A lot of it is pretty low level stuff or just stuff that people need wraparound services and like referrals and stuff like that and not like, you know. ICU or anything like that. But some people do need an ICU and you need to be able to get them there quickly. So I'm excited to see some, we've been working with some different partners to try to imagine birth centers that could also provide more of this. And there are a lot of birth centers that provide prenatal and postpartum care to people who are planning to have hospital births. And there's plenty of evidence that it's beneficial. So I just think these models of care are available to implement in rural areas. And we need to make sure that the regulatory and payment environment can really support that.
Christie - 00:15:48:
So some of our listeners may be familiar with when you say birth center. Some may not. And I don't want to make that assumption. Can I back us up for just a second and you give me an idea of what you mean when you say a birth center?
Amy - 00:16:02:
So I have been working for a number of years around the model of care. That's the freestanding birth center model. And this is. Needs to be understood as both a type of facility and a model of care. So as a type of facility, it's just a freestanding facility, typically for low-risk birth, and that's generally term, head down, like no real risk factors and medical complications. And you're doing a sort of midwifery-style model of care and with an emphasis on physiologic support, kind of natural child birth approach to care. So a lot of movements and tubs and hands-on techniques for pain management, and you have the absence of things like anesthesia and surgery in particular. So that's kind of what defines a birth center is that they're just doing vaginal birth and with a focus on... Low risk, which is kind of defined community by community. And then as a model of care, it's like, you know, it encompasses prenatal and postpartum care. Typically, it's a model that is very relationship based. And so the midwives who are doing the deliveries are doing. You know, we're also seeing these families prenatally and postpartum, and they're doing a lot of education. And there's a whole accreditation framework around this model of care, which I think is... Helpful for talking about it because you can kind of say like, well, at least, you know, when we look at accredited birth centers, we know what the standards and rules are. And so they're really, you know. Integrated facilities that are meant to be integrated into the overall system of care and to have like clear processes and pathways into the hospital for both, you know, in labor, postpartum and for the newborn. And the newborn care is provided by midwives, usually with consultation, obviously with neonatal providers, physicians, but midwives scope includes newborn care. So there's a real emphasis on kind of dyad models of care for the postpartum and there's typically like home visitation. So it's just a really robust model that includes a lot of... Education wraparound support and like, um, you know, and really suits the needs of a certain type of, you know, client, but also could be medically appropriate for, you know, a lot of people. And importantly, just like, creates this access point that again, is like, staffed facility that can do low-risk birth can do a lot of other things too.
Christie - 00:18:42:
Yeah. So it sounds like, you know, one of the things that you're highlighting is risk appropriate care, setting of risk appropriate care. And I know that that is a focus and concern across maternity care, no matter who's providing it. And it's dynamic. It changes. So you can have a very. Traditionally low risk and something can change, you could have somebody that earlier in a pregnancy had custom complications and those complications have improved, passed, been managed. By the patient and or the client. And I think one of the pieces of that means that people transition settings of care. And that is something I know you've done some work on with drills and simulations. And I think... That's one area in particular that, at least in my mind, could really benefit some of our hospitals that may not even have obstetric services in those best practices. Do you mind talking a little bit about drills and simulations and how you see them?
Amy - 00:19:37:
Absolutely. It's one of my favorite topics. So I had the opportunity before I started primary maternity care, I worked for a network of birth centers that were all part of a parent company. And so it was the first real opportunity because most birth centers are one-offs, like they're just these small businesses usually opened by midwives or people who are passionate about the model or whatever. This was, we were trying to build a network. And so we were kind of centralizing functions. And one of the ones that we discovered was like so powerful to do together, but in everyone's own setting was drills and debriefing drill experiences, as well as real cases. So we started a program there where we kind of centralized an approach to drills and we created kind of a community of practice around running drills in our practices. And right now, Tim, you're the head of the community of practice. So what are some of the things that you're doing fast forward? We have a program that we've developed called Step Up Together, and we ran a pilot with just birth centers, some of whom engaged their EMS and hospital partners, but we were really focused on the birth centers. And the current project, we are running a collaborative with 11 birth centers and their partner hospitals around the country. And they are in a community of practice where we are coaching them and they are honestly coaching each other in how to, you know, how to run a program that's really, really powerful. And we're also doing a lot of research around the birth centers and how to conduct a drill that begins in the birth center, travels by emergency transport and ends in the hospital, and then to debrief that drill in ways that turn into, you know, improved practices and better systems for real cases, obviously. And so we developed drill implementation toolkits that can be adaptable. If you're just a hospital that wants to just... Drill, like what would happen if somebody walked in the door from a home birth or from a birth center that, you know, had this case, you can just pick up the drill from that point, or you can just do the birth center component, or you can just do the part in the ambulance so that we can really, you know, because it is a big production and it's taking these, these, you know, practices six months, you know, the full time of the collaborative to organize a drill where you can run the whole thing, but it's still valuable to kind of run. We talk about the three delays, which is something that came from like, you know, global practice where people give birth, you know, on their own in the community, but it's the three delays are the delay and deciding to seek a higher level of care. And that can be a patient delay and, you know, noticing or acknowledging a problem or a midwife or community birth provider delay and like, you know, activating a transfer. So that's delay one. Delay two is, you know, the delay of the delivery of the delivery of the delivery of the delivery of the delivery of the delivery of the delivery of the delivery of the delivery of the delay in reaching the higher level of care. So that usually is delays related to the transport, the mode or the, you know, way of the process of transport. And then the third delay is delays that happen on the hospital end. And those can arise from, you know, people not being ready or not being, not having the case communicated or the level of care that's actually available at the hospital. You've transferred a baby, but there's no neonatal services at this hospital. You know, like you have to really like figure out the whole system and delays, it is very clear it can creep in and often are in all three places or in multiple places when you actually do have poor outcomes. So we're really trying to get everybody in the room and be as collaborative as possible, step up together. The idea is we're all in this together, like step up the safety. We cannot just keep talking about train wrecks and how out of hospital birth is not safe. We can prevent those train wrecks. Like train wrecks in real life prompt like a whole response from the National Safety, you know, Train Safety Board. And like, it involves like root cause analysis and, you know, implementing change. And so it's like. We can't just be like, don't bring me your train wrecks. Let's like actually do the work of understanding what's behind train wrecks and understanding like everybody's role and both preventing and responding to them. So that's kind of what we're up to in the collaborative. It's been a lot of fun. I just got back from... Waverly, New York, which if you look on a map is like in the panhandle, like Western part of, you know, felt like a little bit the middle of nowhere. And so speaking of rural health, that's our most rural participant and they are working. It's a midwife who helped, she worked in the pandemic birth center. So when she was trying to develop this birth center, she was traveling down to New York City from a few hours north, working in this pandemic birth center. But she's doing this beautiful model of care there. And she was working with the neonatal transport team from the referral hospital that is like 40 minutes up the road. But to activate the transport team, it's often a, you know, one to three hour kind of weight of stabilizing a baby and, you know, or versus. Taking the baby seven minutes away to a hospital, but they don't have neonatal services there. So it's like there, there, it was the real, there's a lot of work and planning involved in thinking through different clinical scenarios of like. You know, where, and this isn't unique to birth centers, but birth centers create a container and like an accreditation system to like actually create some systems and best processes for some of this stuff. So it's like, all right, we're going to have babies born and some of them, most of them are going to be, you know, most babies are born and get to go home with their parents. But some of them are going to be born needing, you know, observation for something respiratory or, you know, infection, possible infection. And so you just kind of need to know what the services are at the different hospitals and what the rules are for the different transport systems about their basic life services versus advanced life services. There's actually like so much detail involved in. Assembling a team across multiple sites of care. But again, it's like birth centers are definitely not the only ones having to figure this out, but there's so much already built for birth centers in terms of these, you know, programs and models. So the drill stuff has been, oh, it's like my dream come true. We get to hear so many good stories of. Real improvements that come out of these drills and real like teamwork happening and it's awesome.
Christie - 00:26:03:
So as you're discussing that, I hear a couple themes, and that is taking it outside the walls, right? And knowing that there are partners that have to be engaged in this work. I think one thing we talk about in 1312 Fairmont with state-based teams and perinatal quality collaboratives and other folks is engaging with... Folks across the care continuum and in some of the barriers and limitations, we all, I believe, deeply hold the same goal. We want to see families thrive and we want to see them be well and we want birth to be. Memorable and important and empowering experience, I truly believe. But I also know that sometimes the red tape and the barriers feel insurmountable. It sounds like folks are finding ways to navigate those barriers. Are there any key factors that you think support that or would be really helpful for folks to work on building?
Amy - 00:26:54:
I mean, I think you just named and exhibited one of them is just like always coming back to like, we are about doing the right thing for families and doing safe care wherever it is, you know, and, and being collaborative and there's so much beauty and, you know, awesome stuff that can come out of collaboration and really unlocking like everyone's superpowers. Cause everybody, when you have like a midwife and an OBGYN and a neonatologist and an EMT and a bunch of patients and families, like you actually have so much wisdom right there. And if we can just. Like, you know, nurses, I'm sure I forgot other people, but like, yeah, nurses, I definitely have to mention, like, they have so much to bring to putting together like safe ways of caring for people and getting, you know, the processes so that they're smooth. And so just keeping the focus on patients, I would say, and having like... Proactive collaboration there's so often particularly around like out of hospital birth everybody meets each other when there's a transfer. And when, you know, you usually, if the transfer goes well, you know, people don't bother, but like there's meetings after transfers go poorly. And so the bias becomes that like, oh, all you ever bring us are the train wrecks kind of thing, or like you all, you know, and it's in all directions. And so you really just, everyone needs to understand each other better. And the way to do that is to like break bread together or like do education together or do both things, you know, like to be with each other, not when adrenaline is high and everyone has to explain themselves and get in their corners, you know? So.
Christie - 00:28:39:
Yeah. Yeah, I can see that. I always kind of joke that you don't always build relationship in the middle of a storm while you're bailing out the boat, right? That's not when you want to introduce yourself. I do want to go back to a term that you've used a couple of times as we've talked, because I think it is a term that we are very familiar with in the clinical side of healthcare that can be misconstrued. And I want to make it really crystal clear what we're talking about. When you say train wrecks,
Amy - 00:29:03:
you
Christie - 00:29:03:
are talking about a clinical case and situation that has gone. Poorly. And it isn't the patient, it is the situation. And I think train wreck is actually, it can sound offensive, but I think it actually describes something sort of to your point. When a train wreck occurs, we just had one very significant one in Ohio where there was spillage of substances and there was other pieces there. But there are mechanisms of action. We look at why it happened. We look at the conductor, we look at the train itself, we look at the rails, we look at all those pieces. And so while I think in the past, it's just been used as shorthand, perhaps clinically, it is something we should go back to. But I want to be crystal clear that we're not talking about the patient, their body, or their birth.
Amy - 00:29:50:
Thank you for making that distinction. And I certainly wasn't. I can see how it can feel like that when, and or even. Be, you know, presented that way sometimes, but I think it's so important to be like, no, the experience of the outcome, the, just the chaos of, you know, the event is the train wreck, not, not any individual or anything, but it, it's a really, you know, common thing that you hear from people. It's a, and it's a fear among hospitals of like, they don't want to engage necessarily because they've had these train wreck experiences. And, and it's like, you don't want to like get the more you engage. It's like, well, maybe now I'm responsible for some of these train wrecks if I'm participating in it. But I really think, you know, we have many tools and examples of, and in fact, none of the 11 birth center hospital combos in our thing have any financial or business relationship with, with one another. And I think almost none of them have even like a written, you know, agreement. They just have like collaboration that's happening and agreement to participate. And so I think also like freeing, ourselves of some of the ideas of that, like the vicarious liability from being collaborative. I think there's ways now there's enough examples and ways of like, um, of organizing things to keep everybody. Collaborating and also accountable to their own, you know, profession and so on. And so, you know, we need to continue to understand that, but it can be sort of a blocker of progress to just be like, well, we can't even engage with this.
Christie - 00:31:31:
So. I love the concept of that sort of collaborative partnership with shared goals, right? That sums up what every quality improvement team should be. But it also is in birth. I remember being in labor and looking up from the tub and seeing faces of people that I felt safe with. And that was a collaborative team. I used to joke that birth wasn't a team sport because I wanted to really lift up the voice of the patient in the birthing process. But it is a little bit of a team sport. And especially when things are unexpected or may not follow the traditional pathways or resources, I think there are still ways to have it be beautiful and empowering and minimize, potentially, also trauma to the patient.
Amy - 00:32:19:
Thank you. Yeah. In my former job, when I was helping oversee this network of birth centers, my job was really to put in the learning systems so that we could learn something over here and, you know, flow it across the network. And the first system I put in was patient surveys, and we created a trigger for patient surveys, in particular, who experienced transfer in labor or postpartum, and as well as people that gave birth in the birth center. And we had like tons of data, and it was my job to read like every last one. And it was a privilege. Honestly, I loved reading even the kind of constructive feedback. But I think people, again, when we think about like train wreck as the anchor concept for what a transfer looks like, that's not at all what I was reading. I mean, we did hear from time to time, like something, you know, didn't go smoothly, and patients understood that and picked up on it. But we worked hard to create smooth transfer processes. And they usually worked. And also transfers are usually not emergencies. And so there's time to like acclimate and everything. And, and we also had a model of care that was like so focused on helping people create these beautiful birth plans that are all about like, you know, avoiding intervention and there, and then we're like rolling them across the street to go get all those interventions. And that can create, you know, a lot of challenges for the receiving facility. And, but if they're in communication, the birth center in the hospital with like, well, here's how we are going to communicate to patients ahead of time and prepare them for like, what's going to happen at the hospital. So they're not coming across the street for their Pitocin thinking they're not going to, you know, thinking they can still not have an IV or something like that. You know, like we just have to, or like, there's just education, but once you decide, like, we're in this together, it's not like all of this is solvable. And then, especially when you decide you're like in a community with other people trying to do it too, there's so much to learn. And not have to reinvent the wheel. There are many, many tools for, in particular, like community birth transfer. And I know ACOG is about to release more tools. And so we're tool rich right now. We just need people to like have support. With implementation of those tools and the opportunities to kind of learn from one another.
Christie - 00:34:40:
The concept of community around this, I think, is also applicable even outside of the community birth transferred to a hospital. But I've worked at a variety of levels. I'm a nurse by background. I don't think we've touched on that this season. And I worked at critical access hospitals where, you know. You're trying to get the helicopter, but the helicopter can't come because of the fog. And then you're trying to get an ambulance. And everyone's just hoping we can figure out something. And you're providing the very best care you can in that setting. And then I've worked on the other side when we're receiving transfers from many different places, whether that's a community birth, critical access hospital, whether it's a birth center. And there is a shared language deficit in how folks' expectations are set. And I think as a patient, there has to be, for lack of a better term, some whiplash. And what those expectations are that could potentially lead to misunderstanding trauma and or seeing something as much worse or not as severe, depending on how it's messaged. And I think the concept that the birth center and community birth would speak to a patient about certain expectations when they enter a hospital may also apply for a critical access hospital to prepare a patient for a transfer to a higher level of care. And I'm wondering. What tools you've seen or if you have thoughts on how to optimize that?
Amy - 00:36:03:
Yeah, I'm really excited with our Step Up Together program. So we're currently running this collaborative with the 11 birth centers and their partner hospitals. And we also have funding to develop a tool library that's going to be publicly available later this year in the fall. And it's going to have all of the drill implementation toolkits for 10 different clinical scenarios. And we're going to have them for community birth locations like birth centers and home birth. But we also, they're very modular. And so we're writing them both either in a modular way where they can be done in like a critical access hospital or, you know, a level one hospital or so on. And we're going to have, you know, the ability to kind of sort and find things based on what level, you know, what location they're designed for, including some outpatient scenarios, because that's another place where like community preparedness for perinatal emergencies has to be. And so we're going to have a whole drill library included in that. You talked about like, yeah, it's like the burning platform is what that's called in like. I know I would not wish this mess on my worst enemy, but it's the mess we're in and the platform is burning and we need like all the best ideas and none of the like hubris of like. You know, only these kinds of ideas are good. We've got to be listening to every community and like in particular to the people who've been problem solving all along to care for people in their community with, you know, like shoestring budgets and whatever. Like they probably figured out a few things about like. At least what people need, if not, you know, what some of the solutions are. So I think there's a lot to learn and apply and we definitely don't need to reinvent the wheel at every turn.
Christie - 00:38:13:
I think that takes us to a great jumping off point for the question. So this season, we are asking folks, what is the one thing? We've covered a lot of territory today, whether that's birth settings or recruitment and the Girl Scouts, or just providing really optimized care wherever somebody presents to give birth in a meaningful way and in a way that is as safe and effective and meets their needs as possible. So I want to ask you, as we are wrapping up, what is the one thing that you would want our listeners to know about the topics we've discussed today and or how they touch on rural maternity care?
Amy - 00:38:58:
I think the one thing that I would want to really convey is that we should be building from the community toward the hospital. And when I think of, again, like lowercase primary maternity care and community preparedness for perinatal emergencies and just for pregnancy and birth and postpartum in general. And we need to be able to tap into the assets in communities and respond to the specific needs in communities and have every community have some level of preparedness. And then we need to create really good access pathways into the right level of care. And it's not just level of care. It's like. Permutations and combinations, you know, there's like, maternal level and newborn level. I mean, like that's one thing you have to get both right. And, and there's a million ways to get it right because there's a million different, you know, people trying to give birth, um, you know, or three point something million per year in this country. So, um, personalized care and, and, you know, starting in communities and building, building toward the full system, um, is how we're going to get there.
Christie - 00:40:14:
Well, thank you so much for taking the time to join and talk through these pieces with us. I think a lot of communities. Have a lot to learn from each other, whether they're professional or geolocation diverse. And I appreciate your time.
Amy - 00:40:27:
Yeah, it's been a really fun conversation. Thank you so much, Christy.
Christie - 00:40:34:
Thank you for tuning in to Aim for Safer Birth. If you like this show, be sure to follow wherever you get your podcasts so you don't miss an episode. To get involved in work related to addressing maternal mortality, be sure to check out the Alliance for Innovation on Maternal Health at saferbirth.org. Together, we can work towards safer births and healthier outcomes for all families. I'm Christy Allen, and I'll talk with you next time on Aim for Safer Birth.