October begins the countdown to the 2016 Lamaze International Annual Conference and I am going to highlight the rest of our plenary/keynote speakers from the conference program. These plenary sessions are sure to be the highlight of the conference as we gather to hear the wisdom and knowledge on topics relevant to all birth professionals. Today, we meet Holly Powell Kennedy, Phd, CNM, FACNM, FAAN, who will be speaking about the need to remove barriers that prevent more low risk women from having vaginal births. Read all the plenary speaker interviews here.

Sharon Muza: We know that fewer families (both first time parents and multips) are participating in childbirth education classes and this has been declining for years. How can birth be normalized, especially for the low-risk, healthy parents, if educators don't have face time with these families?

Holly Powell Kennedy: Culture shifts happen over time and are multifaceted. It has taken several decades to get us into this dilemma, but I believe it can be turned around. Over the years, women have had considerable influence in changing maternity practices, from twilight sleep to getting fathers into the labor room. If they believe it is important for them or their babies, they will advocate for it. They are the first critical mass to convince.

The second critical mass is labor nurses - I see such a difference among units and practice, including willingness to do intermittent auscultation (in my opinion), highly correlated to the nursing philosophy.

We know that women do listen to their providers, so their message about this is crucial! If they don't think avoiding cesarean section is important then they will not send that message and women won't care.

SM: The attention span of millennials is shorter than any generation before. How can the message that low risk, low intervention families and babies need/deserve low risk, low intervention births for good outcomes be delivered in a way that meets the learning styles of today's families?

HPK: Materials need to be short and to the point - delivering the message why vaginal birth is important (linking it especially to mother & baby outcomes) and that it requires some level of preparation. It is the first step of parenting.

SM: Midwives are so clearly the appropriate health care provider for healthy low risk pregnant people and the outcomes reinforce this. What can be done to increase the acceptance of the midwifery model of care and the number of providers available to serve qualified families both here in the USA and in other countries as well.

HPK: I find the inverse ratio of midwives to OBs compared to other countries incomprehensible on most levels, but accept that it is a longstanding cultural reflection of medicine in the U.S. Oh so slowly we are seeing more institutions embrace midwifery, but not necessarily the midwifery model - they must go hand-in-hand.

SM: How do you feel the game changer "Safe Prevention of the Primary Cesarean Delivery" jointly released by ACOG and SMFM in February, 2014 is helping (or not?) to lower the cesarean rate in the USA? What recommendation in that obstetric consensus statement do you think is having the biggest impact?

HPK: It may not be politic, but I do not believe it has been a game changer. Although it is an important document (and is a start), it needs more teeth - such that OBs, midwives, nurses, & institutions realize this is a critical health issue. It also does not forefront the evidence on why vaginal birth is important - it is more than avoiding cesareans & resultant complications. It is about why spontaneous physiologic labor & birth are critical in setting the stage for future health, including breastfeeding. The document also avoids intermittent auscultation and barely mentions the importance of labor support. Sigh....

SM: Hospital policies and L&D units/surroundings can have a significant impact on the normal physiology of labor, including the role of hormones in labor and birth and immediate postpartum. Since most families birth in the hospital, what can be done to counteract this interference and increase the likelihood of a normal, low risk healthy birth experience.

HPK: In our study that was just published in BIRTH, the relationship of preparation for the realities of labor and avoiding early labor admission were correlated. Keeping women at home until active labor makes all the difference.

SM: Health care providers who offer obstetric care do not have an education and residency experience that exposes them to normal, low risk birth. How can we expect these providers to offer, suggest and support a low intervention birth when often they have no idea what that even looks like?

HPK: OB chiefs have to buy in to the importance of vaginal birth as a worthy outcome. Leapfrog is working to document cesarean section rates, but do health & malpractice insurers care? Economics have long been a driver - if hospitals lose women b/c they do not believe they have a good chance for a vaginal birth (and want one) there will be changes. Hospitals should look to shared governance with OB & midwifery in managing labor units.

SM: In some communities, midwifery is accepted and respected, but in many places and in many hospitals, there is still a lack of respect, a lack of acceptance and many barriers that stand in the way of midwifery support for low risk healthy families. What do you think needs to happen in order for this to change?

HPK: Public opinion can be changed by women - in either direction. Get them on social media to describe their experiences with midwifery and to challenge systems (hospital, insurance) that put up the barriers to midwifery access.

SM: How did you become involved in this area of research and work? What drew you to choosing to present this topic?

HPK: It's a very long story, rooted in the early 70s as a student nurse where I was evaluated on how well I could do a shave, prep, and enema. Fifteen years later I was exposed to midwifery and floored by their philosophy and skill. It changed my life, both in practice and moved me to research. I will talk about it in my presentation.

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