The California Maternal Quality Care Collaborative is a multi-stakeholder organization in the state of California, United States, that is committed to ending preventable morbidity, mortality and racial disparities in California maternity care. CMQCC uses research, quality improvement toolkits, state-wide outreach collaboratives and its innovative Maternal Data Center to improve health outcomes for mothers and infants. Since CMQCC's inception, California has seen maternal mortality decline by 55 percent between 2006 to 2013, while the national maternal mortality rate continued to rise. The results are pretty outstanding and CMQCC has been a leader for the entire United States in identifying concrete steps that facilities and providers can implement to improve outcomes all around.

One of the focal points that can really make a difference is reducing the number of cesareans done on low-risk, first-time parents. These are first time parents (nullips) pregnant at term with one baby (singleton) in the head down position (vertex). [NTSV] While cesarean sections can be lifesaving in very specific circumstances, the surgery also brings serious risks for parents and their babies. Stakeholders are taking action to reduce these cesareans.

An important component of this effort is patient education. The California Health Care Foundation (CHCF), California Maternal Quality Care Collaborative (CMQCC), and Consumer Reports have partnered to develop and launch My Birth Matters, an educational campaign aimed at informing expectant parents about cesarean delivery. The goal is to support the statewide effort by educating people about the overuse of cesarean sections and encouraging meaningful conversations between patients and their care team.

Here is some more information shared by this newly launched My Birth Matters campaign that you will find very useful as you consider how you can use the tools and videos available from this valuable resource with your childbirth education students.

What is this educational effort all about?

Cesarean sections can be important and even lifesaving in some circumstances. However, studies also have found that overuse of cesarean sections may result in harm to birthing people and babies. Overuse of cesarean sections matters because the surgery brings serious risks both for babies (such as higher rates of infection, respiratory complications, and neonatal intensive care unit stays, as well as lower breastfeeding rates) and parent (such as higher rates of hemorrhage, transfusions, infection, and blood clots).

Additionally, once a parent has had a cesarean section, they have a greater than 90% chance of having the procedure for subsequent births leading to higher risks of major complications, such as hysterectomy and uterine rupture. Unnecessary cesarean sections also drive up costs of care. The total average payment for cesarean sections is nearly 50% higher than for vaginal births, not including associated costs (for example, hospital readmissions, home care, and subsequent cesarean sections).

In the last few years across California, providers, payers, purchasers, policymakers, and others have been working together to reduce the rates of low-risk, first-birth cesarean sections. A key goal is to ensure that cesarean sections are only being performed when they are absolutely needed.

The "My Birth Matters" consumer education campaign has been designed to educate families about the overuse of cesarean sections and to encourage them to engage with their care team to support vaginal birth and reduce their chances of having a cesarean section that could have been avoided. The campaign offers free educational materials in English and Spanish, including brochures, posters, and other print materials designed to be displayed in hospitals and doctors' offices. At the centerpiece of the campaign are four short animated videos (approximately two minutes each) that educate people about cesarean sections and encourage them to share their birth preferences.

Why are they doing this?

In the last few years across California, health care providers, payers, purchasers, policymakers, and others have been working together to ensure that cesarean sections are only being performed when they are absolutely needed. cesarean section rates at California hospitals range from 10% at some hospitals to over 65% at others. The federal Healthy People 2020 initiative, which provides a set of objectives to improve the health of all Americans, set a goal to lower the rate of first-time, low-risk C-sections to 23.9% by the year 2020. That is also the statewide goal for California.

Who is behind this campaign?

The campaign is a joint effort between the California Health Care Foundation (CHCF), the California Maternal Quality Care Collaborative (CMQCC), and Consumer Reports. Research was conducted and prototypes of the communications collateral were tested with consumers and providers and also vetted with a wide range of leading maternity care groups and health care organizations such as the California chapter (District IX) of the American Congress of Obstetricians and Gynecologists (ACOG), the California Association of Midwives (CNMA), and the Hospital Quality Institute.

Who are they trying to reach?

The primary audience is Californians with first-time, low-risk pregnancies across a wide range of incomes, races, ethnicities, and geographic areas. They also wanted to create something that providers and health educators could support, participate in, and feel comfortable sharing with their patients.

What do they want people to learn from this effort and do?

They want people to take cesarean sections seriously and view them for what they are: major abdominal surgery. They want them to talk to their doctors and care team to work together in order to reduce their chances of having a cesarean section unless they absolutely need one.

My Birth Matters recognizes that childbirth education is important.

I love that the My Birth Matters organization talks about how important it is to build a great team. They include and normalize that both a birth doula and a childbirth educator or important and valuable to have and can help improve outcomes. What LCCE educators do is very important!

How can you use this for your classes?

There are different pages under the My Birth Matters website that support information for the following:

• helping families talk to providers
• picking a birth location
• building a care team
• cesarean sections and vaginal births
• tips for a healthy birth
• a well-developed resource list

These pages and accompanying videos (there are four of those) are very consumer friendly, very positive and fact-based. I know I can develop some class activities around this information, as well as ask students to read/watch pre or post class. I hope you will take a few minutes to review the material available and consider introducing it where appropriate in your class content.

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