Family-Centered Maternity Care
Bonita Katz
2014
Family-Centered Maternity Care:
What it is
Why it matters
Objectives
At the end of this session the listener should be able to:
 List at least three professional organizations that have position statements on family-centered
or patient-centered care and briefly describe at least three themes that these statements have
in common.
 State the goal of family-centered maternity care (FCMC).
 Relate the current statistics concerning traumatic childbirth to the need for FCMC
 List at least three “baby-steps” toward making maternity care more family-centered
2000 Public Health Agency of Canada
Family-centred maternity and newborn care is a complex, multidimensional, dynamic process of
providing safe, skilled, and individualized care.
It responds to the physical, emotional, and psychosocial needs of the woman and her family.
1. Birth is a celebration - a normal, healthy process.
2. Pregnancy and birth are unique for each woman.
3. The central objective of care for women, babies, and families is to maximize the
probability of a healthy woman giving birth to a healthy baby.
What is “healthy”?
Does health only apply to physical aspects of a person?
4. Family-centred maternity and newborn care is based on research evidence.
5. Relationships between women, their families, and health care providers are based on
mutual respect and trust.
6. Women are cared for within the context of their families.
7. In order to make informed choices, women and their families need knowledge about their
care.
8. Women have autonomy in decision making. Through respect and informed choice,
women are empowered to take responsibility.
Childbirth education needs to be more of a priority.
9. Health care providers have a powerful effect on women who are giving birth and their
families.
10. Family-centred care welcomes a variety of health care providers.
11. Technology is used appropriately in family-centred maternity and newborn care.
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Family-Centered Maternity Care
Bonita Katz
2014
12. Quality of care includes a number of indicators.
13. Language is important.
2012 JOGNN Call to Action
Quality Patient Care in Labor and Delivery
Endorsed by:
AWHONN
AAFP
AAP
ACNM
ACOG
ACOOG
SMFM
Main themes:
Communication
Shared Decision Making
Teamwork
Quality Measurement
2012 American Academy of Pediatrics
Patient- and Family-Centered Care and the Physicians Role
1. Listening to the family
2. Individualized care
3. Sharing complete, honest, unbiased information
4. Providing formal and informal support
5. Collaborating with families in:
 Professional education
 Policy making
 Program development, implementation, evaluation
6. Recognizing and building on the strengths of individual children and families and
empowering them to discover their own strengths, build confidence, and participate in making
choices and decisions about their health care.
Zwelling & Phillips, 2001
“...the care of mothers and infants after birth [in] the standard hospital setting, with its orientation
toward illness protocols and procedures, is not conducive to helping new mothers and fathers
develop the skills and self-confidence they need to care for themselves or their new infant, or to
enhancing their sense of personal worth and self-esteem.
It is advised that new parents be treated as responsible adults, giving them accurate and
consistent information, letting them make their own decisions, and supporting those decisions
within the realm of proven good medical care.”
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Family-Centered Maternity Care
Bonita Katz
2014
Listening to the Mothers III




Most women do not know when in pregnancy the baby is full term and ready to be
born, and thus are vulnerable to making uninformed decisions about induction when there is
not a medical reason.
Discussion about giving birth after one or two prior cesareans steers many women toward
repeat cesarean, even though research and professional guidelines support offering vaginal
birth to nearly all such women.
o 40% of women were presented with no information about why they should not have a
repeat caesarean
o 3% of women received no information about reasons to have a repeat cesarean
More than one in four of the women in this situation reported that the discussion had
not been framed as a matter of choice.
o Among the 73% of care providers who expressed an opinion about the decision, 88%
recommended repeat cesarean. Ultimately, 93% of the women in this group did have
a repeat cesarean.
LTM trends in breastfeeding
Hospital support for exclusive breastfeeding is improving, although women’s intentions
to and experiences with exclusive breastfeeding appear to be declining.
o Fewer women receiving formula (from 80% to 66% to 49%)
o Fewer babies receiving formula or water supplementation during the hospital stay
(from 47% to 38% to 29%)
o Increase in newborns being primarily in their mothers’ arms in the first hour after
birth from 34% to 47%.
o The percentage of women nearing the end of pregnancy who hoped to breastfeed
decreased from 67% to 61% to 54%.
“Evidence-Based Maternity Care: What it is and What it can Achieve”
Carol Sakala and Maureen P. Corry (2008)
Although most childbearing women and newborns in the United States are healthy and at low
risk for complications, national surveys reveal that essentially all women who give birth in U.S.
hospitals experience high rates of interventions with risks of adverse effects.
Making uninformed decisions means:
 Increased use of unnecessary interventions
 Women may have to live with guilt and regret
 Feelings of incompetence
 Increased risk of bonding issues
 Increased risk of mental health issues
 Partners may feel as though they have failed in some way
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Family-Centered Maternity Care
Bonita Katz
2014
PATTCh
Prevention and Treatment of Traumatic Childbirth

25 – 34% of women report that their births were traumatic

5.6 – 9% of postpartum women exhibit all the symptoms of PTSD

Up to 18% experience symptoms of PTSD, but not enough symptoms for a true diagnosis
4,300,000
X
.18
774,000
Beck, 2004 –
Studies have demonstrated common themes in the experiences of PTSD due to childbirth as:
 perceived lack of communication by medical staff
 fear of unsafe care
 lack of choice regarding routine medical procedures
 lack of continuity of care providers
 care being based solely on delivery outcome
ICEA philosophy
Family-centered maternity care is ICEA's primary goal and the basis of ICEA philosophy. In
1986 ICEA adopted the McMaster University definition of FCMC:
The birth of a baby represents the birth of a family. The woman giving birth and the persons
significant and close to her are forming a new relationship, with new responsibilities to each
other, to the baby, and to society as a whole.
Family-centered reproductive care may be defined as care which recognizes the importance of
these new relationships and responsibilities, and which has as its goal the best possible health
outcome for all members of the family, both as individuals and as a group.
Family-centered care consists of an attitude rather than a protocol. It recognizes a vital life event
rather than a medical procedure. It appreciates the importance of that event to the woman and to
the persons who are important to her. It respects the woman's individuality and her sense of
autonomy.
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Family-Centered Maternity Care
Bonita Katz
2014
It realizes that the decisions she may make are based on many influences of which the expertise
of the professional is only one. It requires that all relevant information be made available to the
woman to help her achieve her own goals, and that she be guided but not directed by
professionals she has chosen to share the responsibility for her care.
Benefits of FCMC:


Increased client satisfaction
o More satisfied with birth experience
o Greater self-confidence
o Increased family bonding
Increased provider satisfaction
o Efficient use of resources
o Greater reimbursement
The goal of FCMC
“Healthy” is NOT only a physical condition
“Healthy” also means the parents are imbued with confidence and competence
as they transition into their new roles
Suggestions:
 Education throughout pregnancy for new families
 Education for providers
 Focus groups
o Providers
o Families
o Families and providers
 Support groups
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Family-Centered Maternity Care
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2014
References
American Academy of Pediatrics. (2012a) Breastfeeding and the Use of Human Milk. Retrieved February
27, 2012, from http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552
American Academy of Pediatrics. (2012b) Patient- and Family-Centered Care and the Pediatrician's Role.
Retrieved April 6, 2012, from http://pediatrics.aappublications.org/content/129/2/394.full.html
Association of Women’s Health, Obstetric, and Neonatal Nurses [AWHONN]. (2012) Quality Patient
Care in Labor and Delivery: A Call to Action. JOGNN, 41, 151-153
Ballen, LE & Fulcher, AJ (2006). Nurses and Doulas: Complementary Roles to Provide Optimal
Maternity Care. JOGNN, 35, 304-311.
Beck, CT. (2004). Post-Traumatic Stress Disorder due to Childbirth: The Aftermath. Nursing Research,
53(4), 216-224.
Coalition for Improving Maternity Services [CIMS]. (1996) Mother Friendly Childbirth Initiative.
Retrieved March 7, 2012, from http://www.motherfriendly.org/MFCI
Childbirth Connection. (2013Data Briefs: Listening to Mothers IIISM in-depth review on topics of
interest to women, consumers, advocates and policy makers. Retrieved September 4, 2014 from
http://transform.childbirthconnection.org/wp-content/uploads/2013/05/DataBriefs-all.pdf.
International Childbirth Education Association. (2012) Mission and Philosophy. Retrieved August 25,
2014 from http://www.icea.org/content/mission
Phillips, C.R. (2003). Family-Centered Maternity Care. Sudbury, MA: Jones and Bartlett Publishers.
Prevention and Treatment of Traumatic Childbirth. (2013). Resource Guide. Retrieved October 3, 2013
from http://pattch.org/resource-guide/.
Public Health Agency of Canada. (2000). Family-Centred Maternity and Newborn Care: National
Guidelines. Retrieved March 7, 2012, from http://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/fcmsmp/index-eng.php
Sakala, C. & Corry, M.P. (2008). “Evidence-Based Maternity Care: What it is and What it can Achieve.
Retrieved October 8, 2013 from http://www.childbirthconnection.org/pdfs/evidence-based-maternitycare.pdf
“You are not allowed to not allow me” (2014) Retrieved August 28, 2014 from
http://birthmonopoly.com/allowed/.
Zwelling, E. & Phillips, C. R. (2001). Family-centered maternity care in the new millennium: Is it real or
is it imagined? Journal of Perinatal and Neonatal Nursing, 15(3), 1-12.
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