Friday, February 19, 2010

Applying the MCFI to virtual maternity care

I'm finishing a project where I analyze whether maternity care providers provide mother friendly care based off the Coalition for Improving Maternity Services Mother Friendly Childbirth Initiative so this technique for analyzing birth care is at the front of my thoughts still. So when I came across this segment of RoboMom, I could not help by apply the MCFI steps to what I observed.

Based on the segment, these are the steps that I see were broken:

Step 1 A, B & C: Husband, family members, doula and midwife were not present.
Step 4: Freedom of Position was not encouraged or allowed.
Step 6A: IV and Electronic Fetal Monitoring were used; both procedures which are not supported by research.
Step 8: Baby was not given directly to mother for skin to skin contact, bonding and breastfeeding. Baby was unnecessarily moved across the room for newborn exam.

Also referring to the preamble of the MCFI which contains something like The Birthing Woman's Bill of Rights, it appears that the birthing woman's preferences were not respected because the "voice" for her did not grant assent to her leg being supported in the human stirrup.

It is unknown from the segment whether the birth was medicated or not and if it was the case that mother felt encouraged by hospital staff to accept pain medication, Step 7 was also broken. Also unknown was whether this labor was augmented or induced by Pitocin which would have been breaking Step 6B.

Good news, an episiotomy was not performed. And it appears that the mother was allowed to push when she felt the urge and was not coached (strongly) by the providers present.

Lastly, and this may not a fair critique since who knows how lifelike this robot is, the doctor should not pull on the baby or placenta while they are being delivered. Such practices have a strong likelihood for doing more harm than good including increasing the likelihood of hemorrhage, retained placenta, perineal tears and physical trauma to the infant. If this were a real situation and the doctor did that, it could also be coded as negatively abiding by Step 6.

This is a project that I would really like to do using footage from TLC's Baby Story. If you think this sounds like fun, let me know. I don't have access to TLC or full episodes, so if you have recorded episodes or know if you can by seasons online, tell me.

I even have the spreadsheet to quickly code for each principle and step for the MCFI on hand!


Jennifer said...

If we could figure out the copyright issue, I could make a video montage showing where they break each step, going step by step and using several clips from the show. How do people get permission to do that?

Jenne said...

I have no idea. Rixa might now since she did a video montage of scenes from movies for the Trust Birth Conference in 2008.

Anonymous said...

This is a great idea. Also, I think it'd be cool if there was a website out there where you could link to a video and complete an online MFCI assessment.... wonder how many cans of worms that would open...

I don't like watching A Baby Story or related shows, but sometimes I ask my partner to sit down and analyze the shows with me to see what decisions we might make if we were in the shoes of the parents on the show. Using specific situations seems to make more sense to him; it's been a conversation starter, a way for us to communicate with each other about the kind of birth experience we want. (Our overarching conclusions are usually very much in alignment with the MFCI.)

Jenne said...

I really don't like watching A Baby Story either. I get so frustrated with the number of things that are wrong regarding informed consent, especially accurate descriptions of risks, evidence-based practices, needless interventions, fear mongering, etc.

This is one I can think of quantifying what is wrong with the show. If I could prove a point and in some objective way analyze the awful things being done to women on the show in the same of trusting their doctor, I could bring myself to watch it. And in some way try to counteract the misinformation the show in promoting.

This is one topic that can be emotionally draining to analyze because some of the violations against women are blatant (but missed) and this is with scrubbed clean versions so doctors aren't portrayed as abusive and cruel. We don't have those performances on video though, and yet A Baby Story can still be insidious enough.

As I've done The Birth Survey data analysis, I've actually been pleasantly surprised by the positive comments that women have left about their hospital providers. They have overall been more positive than I expect. It is a disservice providers to claim that all OBs are awful, because they aren't.

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