The Lamaze International 2020 Childbirth Education Advocacy Summit, in Washington, DC, is approximately ten weeks away! Plans are being finalized to offer an amazing array of Pre-Summit Workshops and Keynote speakers.  Early bird pricing is accessible through March 9, 2020 for the May 18-19 Summit.  I took a moment to check in with Debra Bingham, DrPH, RN, FAAN​, one of the Summit's three Keynote speakers. Dr. Bingham's exciting session is titled "Advocacy in Action:  Lamaze Education as Part of High Value Maternity Care."  In today's interview, we learn Dr. Bingham's thoughts on the role of childbirth education in today's maternal-infant health landscape.  Dr. Bingham's bio and contact information can be found at the end of her insightful interview.

Sharon Muza:  How would you answer this question- “My presentation at the Lamaze Advocacy Summit will be a success if…?”

Debra Bingham: My presentation will be a success if the individuals who attend feel inspired to advocate for state and local funding that makes it possible for all people to have access to affordable childbirth education. People need information in order to know what their reproductive options are and to enhance their ability to ensure that they have shared decision-making with their health care provider.

SM: What would your response be if a pregnant person asked you why it is important to take childbirth education classes during their pregnancy?  What should they look for when selecting a childbirth education class?

DB: It is important for pregnant people to obtain childbirth education so that they are better able to make informed decisions and better understand the implications of their decisions. The decisions they make during childbirth will affect their entire reproductive life course. For example, a pregnant person who know about the benefits of spontaneous labor and the risks of having a non-medical induction is in a better position to advocate for themselves. They can make choices that are consistent with their reproductive life goals. 

SM: What is the biggest challenge currently facing childbirth educators today and do you have any thoughts on a potential solution?  Where are we missing the mark?

DB: The biggest challenge is making sure that childbirth education is accessible to all pregnant people regardless of their race/ethnicity and ability to pay. Three of the biggest challenges to achieving this vision are 1) financial barriers which include the tension between having inexpensive or free culturally sensitive childbirth education options readily accessible and paying childbirth educators a living wage, 2) inadequate numbers of certified childbirth educators to ensure all families have access to someone qualified to provide them evidence-based information in a non-biased manner, and 3) inadequate numbers of non-white childbirth educators so that childbirth educators mirror the race and ethnicities of their communities.

SM: In your opinion, has there been any successes in recent efforts to change our maternal mortality crisis, particularly for BIPOC families who are most impacted?  Where are we still failing miserably?

DB: When I am asked why there is a rise in maternal mortality and morbidity, I usually flip the question and ask instead what has changed since the 1990s?  Several practices have changed, with no evidence to indicate that these changes have led to improvements in outcomes:

1. One third of birthing people are having cesarean births, this is major surgery that causes what are known to be serious short- and long-term risks for the person who had the surgery and for the newborns. One of the reasons for this increase is less access to a trial of labor after a cesarean. ;
2. There are more non-medical inductions of labor; and
3. Pregnant people are being admitted earlier in labor which exposes them to a cascade of interventions that reduce the number of people having physiologic labors and births.

In addition to the increase in maternal mortality for white people, there are three to four more Black or Brown people dying or suffering from preventable injuries. These are long-standing inequities that are unacceptable and exist regardless of education level and socio-economic status. In order to eliminate these disparities, white people, in particular white health professionals need to ensure equity in access to clinical interventions, education, and services.

Many of the disparities we see can be eliminated. But, these disparities will only be eliminated when all perinatal professionals, including childbirth educators, SPEAK UP.  SPEAK UP stands for: 

S- Set limits, do not allow racial comments or actions to occur in your presence, even if the comment was meant to be a joke.

P – Practice and prepare. Racial biases will emerge, we all need to prepare how we will respond to our own biases and those we see in others.

E – Express concerns. Express concerns in a way that does not blame or shame others.

A – Apologize when we do or say something that we regret or that is hurtful to others.

K – Keep improving. Never stop trying to eliminate racism from perinatal health care.

U – Uncover and learn. Track and report data by race and ethnicity.

P – Persuade others to SPEAK UP.

Conversation is where change begins.  Too many people feel like inequities in outcomes is something that others needs to fix. But, each one of us can SPEAK UP. Go to:  www.perinatalQI.org to learn more about the SPEAK UP training and Action Pathway.

DB: I am excited to connect with like-minded individuals who care deeply enough about improving childbirth outcomes that they are coming to Washington, DC to advocate for change. I look forward to joining with my Lamaze colleagues as we continue to work to ensure that the United States becomes the safest place in the world to give birth.

About Debra Bingham, DrPH, RN, FAAN​

Dr. Debra Bingham has over 30 years’ experience in Maternal Child Health Nursing, a master's degree in perinatal nursing from Columbia University, and a doctorate in Public Health from the University of North Carolina-Chapel Hill. Most of Debra's career has been spent working in hospital leadership positions at the front lines of healthcare. Debra has expertise in Quality Improvement (QI), health care safety, and implementation. Her focus is on expanding front-line clinician’s quality improvement implementation effectiveness. She has developed and led state and national QI initiatives that have led to improvements in maternal outcomes. For example, she was the first executive director of the California Maternal Quality Care Collaborative, the Vice President of Research, Education, and Practice for the Association of Women’s Health, Obstetric and Neonatal Nurses, the former chair of Lamaze International’s Institute for Safe and Healthy Births.  Currently Dr. Bingham is an Associate Professor of Healthcare Quality and Safety at the University of Maryland School of Nursing where she is advising the faculty on how to expand the utilization of implementation science and improvement science theories, frameworks, models, and QI methods and tools within the Doctor of Nursing Practice curriculum. She is the principle investigator for the Advancing Implementation Science Education (AdvISE) grant funded by the Maryland Nurse Support Program II, which in turn is funded by the Maryland Health Services Cost Review Commission and administered by the Maryland Higher Education Commission. She is also a perinatal consultant and the founder and Executive Director of the Institute for Perinatal Quality Improvement (www.perinatalQI.org). PQI has developed the Implementing Perinatal Quality Improvement course, the anti-racism implicit bias training SPEAK UP Action Pathway, and is working to expand the use of intermittent auscultation (IA) by releasing simulation-based on-line education. Dr. Bingham's contact info: www.perinatalQI.org, dbingham@perinatalQI.org, Twitter:  @perinatalQI and @Debra_Bingham.

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