What does ChatGPT know about Maternal Health?

 ChatGPT is a phenomenon that is causing both concern and excitement in academic circles.  The concern is about students being tempted to use the AI to write their essays.  The excitement is about students learning to critique what the AI program writes in response to questions.  There is also conversations about whether AI can mark students assignments!  I enjoyed reading this article by Mark Schaefer on Medium outlining 20 Entertaining Uses of ChatGPT You Never Knew Were Possible. 

I like asking the AI questions, to see what comes up.  I am teaching a course about Global Maternal Health so thought I'd ask it "what's happening with Global Maternal Health".  The response was: 

Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. While progress has been made in improving maternal health globally, there are still significant challenges that need to be addressed.

According to the World Health Organization (WHO), approximately 810 women die every day from preventable causes related to pregnancy and childbirth. Most of these deaths occur in low-income countries, and the majority of them are due to complications such as severe bleeding, infections, high blood pressure, and unsafe abortions.

In addition to the high maternal mortality rates, many women also suffer from complications and long-term health problems related to pregnancy and childbirth, such as obstetric fistula, which can cause incontinence and social stigma.

To address these issues, efforts are being made to improve access to quality maternal healthcare services, including skilled birth attendants, emergency obstetric care, and family planning. The WHO has set a target of reducing the global maternal mortality ratio by at least 70% by 2030, and many countries are working towards this goal.

However, the COVID-19 pandemic has had a significant impact on maternal health, with disruptions to healthcare services and increased health risks for pregnant women. It is essential to continue prioritizing maternal health and to address the ongoing challenges and inequalities that affect women's health and well-being globally.

A reasonable overview but no mention of the Sustainable Development Goals, although the WHO goal to reduce maternal mortality ratio by 2030 is a nod in their direction. 

I then asked 'What can we do locally to improve maternal health?' The response was: 

Improving maternal health requires a multi-faceted approach that involves various stakeholders, including healthcare providers, policymakers, community organizations, and individuals. Here are some actions that can be taken locally to improve maternal health:

1. Increase access to quality maternal healthcare services: Pregnant women should have access to affordable and high-quality healthcare services, including antenatal care, skilled birth attendants, emergency obstetric care, and postnatal care.

2. Promote maternal health education: Educating women and their families about healthy pregnancy practices, including proper nutrition, exercise, and prenatal care, can help prevent complications and improve maternal and fetal health.

3. Address social and economic factors: Social and economic factors, such as poverty, lack of education, and gender inequality, can impact maternal health. Addressing these factors through programs that promote economic empowerment, education, and gender equality can improve maternal health outcomes.

4. Encourage family planning: Access to family planning services can help women plan and space their pregnancies, which can reduce the risk of maternal and infant mortality.

5. Support community-based initiatives: Community-based initiatives, such as support groups for pregnant women, can help provide emotional support, promote healthy practices, and address cultural and social barriers to maternal healthcare.

6. Advocate for policy change: Advocating for policies that promote maternal health, such as laws that improve access to healthcare services and promote gender equality, can help improve maternal health outcomes.

By taking these actions, individuals and organizations can work towards improving maternal health locally and contribute to the global effort to reduce maternal mortality and morbidity

Again, a good general response. Interestingly skilled birth attendants are mentioned but not continuity of midwifery care which actually has been found to tick all the boxes outlined in the list of the multifaceted approach.  The Millennium Development Goals (MDG's) focused on the provision of skilled birth attendants and in terms of global maternal health, the ratio has worsened in many regions. 

So I asked "how can continuity of midwifery care contribute to global maternal health? 

This was the response: 

Continuity of midwifery care refers to the provision of care by the same midwife or a small group of midwives throughout pregnancy, birth, and the postpartum period. This approach has been shown to have several benefits for maternal and newborn health, including:

1. Improved outcomes: Continuity of midwifery care has been associated with reduced rates of preterm birth, low birth weight, and neonatal mortality. It can also reduce the need for interventions such as cesarean (US spelling) section and epidural anesthesia (US spelling).

2. Improved maternal satisfaction: Women who receive continuity of midwifery care report higher levels of satisfaction with their care, as they develop a relationship of trust and familiarity with their midwife.

3. Cost-effective: Continuity of midwifery care has been shown to be cost-effective, as it reduces the need for interventions and hospitalizations.

4. Increased access: By providing care in the community, continuity of midwifery care can increase access to care for women who live in rural or remote areas.

Implementing continuity of midwifery care can be challenging, especially in low-resource settings where there may be a shortage of midwives or other healthcare providers. However, this approach can contribute to improving maternal health globally by providing women with high-quality, personalized care that addresses their individual needs and preferences. It can also help reduce the global burden of maternal and newborn mortality and morbidity, particularly in low-income countries where access to quality maternal healthcare services may be limited.

Rather good overview by ChatGPT of continuity of midwifery care, don't you think?  If ChatGPT knows the benefits, then we must make sure that our politicians and policy makers know too.  

Preparing midwifery students to provide continuity of care

Continuity of midwifery care provides superior maternal and neonatal outcomes (Sandall et al., 2016). Access to continuity of care models is limited, both for women and for midwifery students who have the opportunity to gain direct experience of such models. There is also concern that placing students in a continuity of care model rather than a standard hospital model of care may reduce their learning.

New research from Professor Kathleen Baird, Ms Carolyn Hastie, Ms Paula Stanton and Emeritus Professor Jenny Gamble of the Transforming Maternity Care Collaborative focussed on the learning experiences of students who complete an extended placement in a midwifery group practice providing continuity of care at one university (Baird et al., 2021). Final year midwifery students were able to elect to take part in a six-month placement in a midwifery group practice team. The research team conducted focus group interviews to explore the experiences of fifteen students who had taken part in the placement.

Students reported that their placement in the midwifery group practice was the highlight of their degree and was not as demanding as they had anticipated. Being able to develop skills in providing relationship-based care was highly valued by students and was enabled and supported by the midwives they were working with. The culture of the midwifery group practice in which students were placed provided a supportive environment were students learned to take care of themselves and their team members, and to collaborate with other members of the team. Students felt that they were valued members of the team. Returning back to the hospital shift-based system was challenging for most students. They were aware of a loss of autonomy and a faster pace of care. Some were supported well in this transition, while others were criticised for their choice to spend time in the midwifery group practice.

This research enables midwifery educators to feel confident that prolonged immersive student placements in midwifery continuity of care models provides positive learning experiences. The students described feeling and acting like a “real midwife” during their placement, with six being adamant that they would apply for a position in a midwifery group practice immediately after graduation. Increased access to midwifery continuity of care models for women would provide more opportunities for midwifery students to gain experience of working in this model.

 

Baird, K., Hastie, C. R., Stanton, P., & Gamble, J. (2021). Learning to be a midwife: Midwifery students’ experiences of an extended placement within a midwifery group practice. Women and Birth. https://doi.org/10.1016/j.wombi.2021.01.002

 

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016, Apr 28). Midwife-led continuity models versus other models of care for childbearing women. [Meta-Analysis]. Cochrane Database Syst Rev, 4(11), CD004667. https://doi.org/10.1002/14651858.CD004667.pub5

 

This précis of our research has been reproduced from the Transforming Maternity Care Collaborative website 

Why the way maternity care is provided has to change!

You have to read this post!  It clearly demonstrates all that's wrong in contemporary maternity care.

Nathan is leaving the building and he is exactly the kind of obstetrician we need to help stop the madness of modern maternity 'care'.  

He writes: 

The life of a hospital-based OB/GYN is misery. Phone calls throughout the night to fix problems that we created through attempts to induce or intensify birth surges are a prime example of how our priorities have become totally ass-backwards.

Read on ... 

Click the link below to read Nathan's heartbreaking and yet inspiring reflection - he shows clearly what needs to  happen

On my departure from hospital-based birth - a reflection

Modern maternity care has become a self-fulfilling hampster wheel of fear and intervention, becoming more and more disabling for everyone involved.  Nathan nails it.  Let's change it.

We need to move entirely to woman-centred care; let's provide continuity of midwifery care; let's leave things alone until there are signs some help is needed - let's not break women's birth processes and then have to fix them.   Let's not use war metaphors for our practice - women don't need pre-emptive strikes, but they do need loving support, kindness and safe places to explore what becoming a mother means - as does her partner need the same care.

Let's do it and bring back Nathan and all the other Nathans and midwives who leave in disgust at home the system traumatises everyone.

The image below is from Nathan's Blog Post and I thought it apt, very apt ...
 

Is it time to ditch birth plans?

An article in the Lifestyle section of the Sydney Morning Herald on November 20, 2019, says it is.


In the article, The 'birth plan' is a shortcut to disappointment, time to ditch it', Polly Dunning explains the birth plan has served its purpose as it has brought women back into the conversation about their bodies and what happens to them at birth, however only 58% of childbearing women feel like they got the birth they wanted and one in three women emerge from their experience traumatised. Dunning writes that the birth plan has failed women, causing unrealistic expectations and there is no consistency in how they are written, nor how they are utilised by health professionals.

Catherine Bell of bellabirth

I was talking with Catherine Bell, a researcher, doula and author/creator of The Birth Map who has been quoted in the article in the Sydney Morning Herald about this idea of ditching the birth plan.

Catherine said

 Birth plans were introduced in the 1980's to address the decreased sense of agency experienced by pregnant women with the increased medicalisation of birth. Intended as a communication tool, but falling way short as many plans are ignored or mocked, are created in isolation or using a template. Women are told to 'be flexible' which is code to 'comply'. They are encouraged to use 'preferences' or state 'wishes'. 

Working with women and their families during pregnancy, exploring hopes, fears, dreams and desires finding out what women want, exploring ways to enable and facilitate what women want is at the heart of midwifery continuity of care. The evidence is compelling and clear that women, their babies and their families are more satisfied, healthier, happier and more able to have the birth they want than women engaged with the fragmented maternity care system. Governments are yet to fully fund a maternity care system that has continuity of midwifery care as its 'norm'. Even though the latest Australian National Strategy for Maternity Care has 'woman-centred care' as its heading, it is still talking about health professionals of choice; not a firm commitment to providing best practice care and a health system reorganisaton of services to ensure every woman has her own midwife.

In the article by Dunning, Catherine was quoted talking about the difference between informed consent and informed decision-making.  The distinction is an important one.  We see informed consent in action when an anaesthetist, called to do an epidural in a difficult labour, runs through all the risks, benefits and contraindications for the stressed and often distressed woman to obtain her consent for the procedure. We see the same dynamic with medical interventions of all kinds in the fragmented maternity care system.

Informed decision making, however, is a process of providing unbiased, evidence-based information to women and their families ahead of time, having ongoing conversations to explore thoughts, feelings, fears and interests in a calm relaxed and thorough manner, considering alternatives and 'what ifs'.  As mentioned above, this process is at the heart of continuity of midwifery care.

As less than 10% of Australian women have access to continuity of midwifery care, Catherine has developed the birth cartography approach to birth preparation. "Like an Advanced Care Directive, this approach boldly goes where no birth plan has gone before". The birth map process enables couples to explore the evidence and their thoughts and feelings, consider alternatives and think about different pathways that may open up during labour, birth and beyond - to consider their options ahead of that all-consuming process of welcoming a newborn earthside.

Catherine invites you to look at her website for further useful information about birth maps. Catherine's website is found at www.bellabirth.org

Used with permission