Monday, May 23, 2:00 - 3:45 PM (Opening General Session) Health System
Complexity and the Cesarean Epidemic
Neel Shah, MD, MPP
In just one generation of mothers, cesarean delivery rates in the United States have skyrocketed by 500% to become the most common major surgery performed on Americans. Contrary to conventional wisdom, the reasons for the rapid rise are unclear. It is poorly explained by changes in reimbursement, malpractice, patient risks, or patient preferences.
The optimal cesarean rate is challenging to discern but as many as half of cesareans performed on Americans may be avoidable. Each year, unnecessary cesareans come at the cost of $5 billion in excess spending, 20,000 major surgical complications, and unmeasured pain and suffering. This suggests a massive systems failure that requires a systems solution.
While there are no easy answers, recent data offers an important clue. There is tremendous variation in cesarean rates by hospital--ranging from 7% to 70%. This means that in 2016 a mother's greatest risk factor for getting a cesarean may be which hospital she goes to. This talk will explain efforts to understand what makes "Hospital A" different from "Hospital B" and how this understanding may inform the design of a scalable intervention that measurably improves the care of mothers and babies.
Dr. Neel Shah, MD, MPP, is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, and associate faculty at the Ariadne Labs for Health Systems Innovation. He is an expert in designing, testing, and spreading system interventions that improve patient care. As a general obstetrician-gynecologist at Beth Israel Deaconess Medical Center, Dr. Shah cares for patients during critical life moments that range from surgery to primary care to childbirth.
Prior to joining the faculty, Dr. Shah founded Costs of Care, a global NGO that curates insights from clinicians to help delivery systems provide better care at lower cost. He is listed among the "40 smartest people in health care" by the Becker's Hospital Review, and has been profiled in the New York Times, the New England Journal of Medicine, and other outlets.
In 2015, Dr. Shah co-authored the book Understanding Value-Based Healthcare (McGraw-Hill), which Don Berwick has called "an instant classic" and Atul Gawande called "a masterful primer for all clinicians." He serves on the advisory boards of Square Roots, the Healthcare Financial Management Association, and the National Partnership for Women and Families.
Wednesday, May 25, 8:45 -- 9:45 AM (Premier Session)
Maternal Health Disparities and Midwives: Why Racism Matters
Vernellia Randall, JD, MSN
Racial health disparities, particularly maternal health, isa significant issue.In this premier session Professor Randall will describe the relevant health status of African Americans to White Americans (with specific attention on maternal and neonatal health), define race and racism, and explain the role of race and racism in health care disparities. She'll also explain the interaction of embedded social/racial inequalities and personal behavior on health status with particular attention on the impact of racial stress on maternal health. Professor Randall will also discuss discrimination in health care and its role in health disparities as well as the role of the law in eliminating racism and discrimination. Given her 50 years history of working on these issues, she will explore how racism impacts diversity in the midwifery profession and thus health disparities.
Professor Emeritus Vernellia Randall received her AA degree from Amarillo College, her BS degree from the University of Texas School of Nursing, her MS degree in nursing from the University of Washington, and her JD degree from Northwestern School of Law, Lewis and Clark College. She has completed postgraduate work in public health. Professor Randall served as Maternal-Child Health Nurse Coordinator for the State of Alaska. She has been a professor of nursing and community health as well as a law professor. During the 24 years teaching, she taught a wide variety of courses including American Health Care Law, Race and Racism in American Law. Highly sought after as a public speaker on matters of health and race, Professor Randall has also published widely. Her website, Racism.org has been on the web since 1995. Her latest book is entitled Dying While Black.
Thursday, May 26, 9:15 -- 10:15 AM (Therese Dondero Lecture)
Equity and Human Rights Challenges for Women's Health Care in a Rapidly Changing World
Mary Ellen Stanton, CNM, MSN, FACNM
While maternal mortality fell by 44% globally between 1990 and 2015, it fell far short of the Millennium Development Goal target of 75%.There is now a staggering 80-fold difference in lifetime risk of maternal death for women in low-income countries compared with high income countries. Even in countries where risk of maternal death has been significantly lowered, massive inequities remain across income strata. Certain groups of women are particularly vulnerable. Women who are HIV positive may be stigmatized, adolescents marginalized, women heads of households ignored, migrants ostracized, and women from disadvantaged indigenous, ethnic, racial, and tribal groups mistreated during the course of care.
The Global Burden of Disease shows that with life expectancy increasing, the major causes of death of women of reproductive age are changing relative to each other. Maternal causes are becoming less significant relative to non-communicable and communicable diseases and injuries. It is critical that the unfinished agenda of ending preventable maternal death worldwide is realized, while also addressing maternal disability, unmet need for family planning, and important risk factors that affect women's ability to not only survive, but thrive.
The Sustainable Development Goal for Health calls for universal health coverage. Evidence from research, analyses from human rights organizations, and stories unearthed in the media indicate that while women are living longer-and increasingly using maternity services-when they present themselves for care, they are too often disrespected, neglected, and abused. This constitutes a violation of trust between women and their health care providers. Mistreatment of women in childbirth and in other reproductive health services is a violation of a woman's fundamental human rights.At the same time that we roll back these human rights abuses in this dynamic health care environment, we must also appreciate the need of midwives for empowerment and respect.
Mary Ellen Stanton is Senior Maternal Health Advisor to United States Agency for International Development (USAID) where she guides the Global Health Bureau's maternal health portfolio, including research and implementation of country programs. She is the Team Leader for Maternal Health in the Division of Maternal and Child Health, serves as the USAID Washington-based coordinator for the Afghanistan Health Program for the Bureau for Global Health, and manages USAID's obstetric fistula program. She has helped to develop USAID's advocacy and implementation research activities to address the problem of disrespect and abuse of women during childbirth in health care facilities. Ms. Stanton received her BA from Oberlin College, BS from Columbia University, and MSN. from the University of Illinois. She is a Fellow of the American College of Nurse-Midwives. In 2015 she received the ACNM Hattie Hemschemeyer Award and the University of Illinois Alumni Association Humanitarian Award.
Thursday, May 26, 12:00 - 1:30 PM (Closing Premier Session)
Addressing Maternal Health Challenges in the United States Using the Midwifery Model of Care
Christy will be our closing premiere speaker, participating in a fireside chat on maternal health challenges with Dr. Cara Osborne, CNM, MSN, ScD. The United States spends more per person on health care than any nation, yet we are one of only 13 countries where maternal deaths are rising. Our maternal mortality rates have more than doubled in the last 25 years. Today, women are more likely to die from pregnancy and childbirth-related complications in the United States than in Iran, Serbia, and Bosnia. Black women are 3-4 times and Hispanic women are 50% more likely to die during birth than white women. Data shows that midwives and doulas can improve medical outcomes, control costs, and reduce health disparities. That is why Every Mother Counts is calling on insurance companies and state Medicaid programs to fully reimburse for midwifery and doula care in all 50 states, and provide resources for policyholders to educate women and families on their options. This is the first step we need to take to give women access to the care they need.
Having endured a childbirth complication herself, Christy Turlington Burns was compelled to direct and produce the documentary, No Woman, No Cry about maternal health challenges that impact the lives of millions of girls and women around the world. Every Mother Counts (EMC) was launched at the same time as an advocacy campaign to heighten awareness about our global maternal health crisis. While advocacy remains a key focus, EMC has evolved into a 501(c)(3), investing in programs around the world to ensure all women have access to quality maternal health care. Christy Turlington Burns has been recognized as one of Time's 100 Most Influential People and Glamour Magazine's Woman of The Year. In March 2016, EMC was recognized as one of Fast Company magazines Top 10 Most Innovative Companies in Not-For-Profit. Prior to her work as a global maternal health advocate, Christy Turlington Burns enjoyed a successful career as a model while continuing her education and pursuing other interests. Christy Turlington Burns is a member of the Harvard Medical School Global Health Council and on the advisory Board of New York University's Nursing School. She holds a BA from NYU's Gallatin School of Individualized Studies and has studied Public Health at Columbia University's Mailman School of Public Health. A 4-time marathon finisher, Christy resides in New York City with her husband, filmmaker Edward Burns, and their 2 children.