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Objectives Retained As Is From Healthy People 2010
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MICH HP2020–4:
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Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery).
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Status: Retained Healthy People 2010 objective 16-5.
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View Objective Comments
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Objective Clarification:
Limiting this to complications during hospitalized labor and delivery, excludes important considerationssuch as managing prexisting considtions during pregnany and the immediate postpartum period
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Status:
The American College of Nurse Midwives strongly supports the retention of this objective.
We call attention to the increased maternal morbidity associated with cesarean deliveries.
“Although C-sections have been effective in saving lives, they also can increase the risk of illness and death.” (http://www.healthypeople.gov/data/micourse/html/focusareas/FA16ProgressHP.htm.healthy people 2010)
Even cesarean deliveries that are planned and non-emergent may increase maternal morbidity.
After controlling for age, parity, and race or ethnicity, mothers with a planned primary cesarean were 2.3 times more likely than those with planned vaginal birth to require a rehospitalization in the first 30 days postpartum.
Declercq, Barger, et al. 2007. Maternal Outcomes Associated with Planned Primary Cesarean Births Compared with Planned Vaginal Births. Obstetrics and Gynecology, 2007; vol. 109, no. 3, 669-677.
It will not be possible to achieve progress on this objective without continuing efforts to reduce the primary cesarean section rate (HP2020-6).
ACNM proposes a new objective for Healthy People 2020 to increase physiologic birth to 70% among women with a full-term, singleton, vertex presentation infant.
Adoption of the objective will help to reduce the cesarean delivery rate and reduce maternal illness and complications due to pregnancy.
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Objective Text:
ASTPHND recommends modification:
Add-
Reduce obesity, diabetes and hypertension preconception and during pregnancy.
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Objective Clarification, Objective Text:
Rewrite Objective: Reduce maternal illness and complications due to pregnancy and in the immediate postpartum period (complications during hospitalized labor and delivery).
Rationale: It is important to measure complications in the immediate postpartum period, as well (e.g., early and late postpartum hemorrhage; eclampsia – about 25% of eclamptic seizures take place in the postpartum period).
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The March of Dimes Foundation strongly supports retaining this objective in Healthy People 2020.
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Objective Clarification:
With postpartum depression (PPD) being the #1 complication of childbirth--and with PPD (not to mention, antepartum depression as well) comes the potentially negative long-term impact on childhood development--I find it UNFATHOMABLE that perinatal mood disorders are not included on your list of objectives under Maternal, Infant and Child Health!
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Objective Text:
It is vital that mental illness during the perinatal and postpartum periods are addressed as parts of "maternal illness" and "complications due to pregnancy," since postpartum depression is the most common complication of pregnancy. There is a huge information gap when it comes to information, education, awareness, and advocacy on this topic. Many, many practitioners are not doing routine screenings, and perinatal and postpartum mood disorders are wreaking havoc in the lives of women and their families. Please be sure to include this very important topic in your list of objectives.
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Objective Clarification:
An increase in perinatal mood disorder screening, treatment, and patient/practioner education is critical to maternal, infant and child health objectives. With the limited data available thorugh the CDC which reports over 1 million women self reporting every year, this is a healthcare crisis with substantial and long term negative effects on families and children.
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Objective Clarification:
Postpartum Depression is the number one complication of childbirth. We can help reduce the number of women who needlessly suffer in silence by providing education, screening and early intervention.
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Objective Clarification:
Given that postpartum depression is the #1 complication of childbirth, please make sure that PPD is included as one of the pregnancy complications that should be reduced.
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Objective Clarification, Objective Text, Data Source:
When addressing inpatient complications, might add elective induction of labor, and unnecessary cesareans. For data sources, www.childbirthconnection.org, www.lamaze.org, www.acnm.org (excellent sources for laypersons and healthcare professionals). Also, amniotic fluid embolism, as frequently fatal, though rare complication, has been associated with use of oxytocin for induction/augmentation of labor.
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Objective Clarification, Objective Text, Data Source:
What pregnancy complications are going to be included in this objective - infection, hemmorhaging (during labor), pre-eclampsia, etc.?
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Objective Text:
To clarify previous comment:
Add: Reduce obesity, diabetes and hypertension during preconception and pregnancy.
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Objective Text:
Reduce obesity, diabetes and hypertension preconception and during pregnancy.
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Objective Clarification:
add a subobjective to address need to reduce maternal depression and mental illnes
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Objective Clarification, Objective Text:
Not only should we Reduce maternal illness and complications due to pregnancy but we should reduce maternal illness that cause complications in pregnancy such as obesity, diabetes and hypertension.
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Objective Clarification:
I second the prior comments regarding obesity and diabetes. It is unlikely that this will be sucessful without addressing the root cause.
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Objective Clarification:
The fact that the mean age of pregnancy is increasing, diabetes is more prevalent, obesity is rampant and the cesarean section rate is going up makes this goal unrealistict. The number of complications during pregnancy and postpartum will go up because of the lifestyle of patients and the morbidity that patients have prior to pregnancy.
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Content for this site is maintained by the Office
of Disease Prevention & Health Promotion,
U.S. Department of Health and Human Services.
Last revised:
October 30, 2009
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