Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing

June 2018
Maternal Health


The Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing aims to chart an efficient pathway to a maternity care system that reliably enables all women and newborns to experience healthy physiologic processes around the time of birth, to the extent possible given their health needs and informed preferences. The authors are members of a multistakeholder, multidisciplinary National Advisory Council that collaborated to develop this document.

We face an exciting opportunity to achieve a full, high-performing maternity care system for all women, newborns and families.

Knowledge about the importance of perinatal physiologic processes for healthy maternal-newborn outcomes has come into sharper focus and garnered growing attention in recent years. Fostering healthy physiologic processes whenever possible is a preventive approach to health and safety for childbearing women and their newborns. Promoting, supporting and protecting these processes contributes to healthy outcomes in women and their fetuses/newborns. These processes facilitate such crucial matters as fetal readiness for birth and safety in labor, labor progress, reduced stress and pain in labor, safe maternal and newborn transitions and adaptations after birth, effective breastfeeding and secure maternal-newborn attachment. Growing evidence of longer-term effects of care around the time of birth also underscores the importance of fidelity to optimal maternal-newborn care. Leading professional organizations increasingly provide guidance for promoting, supporting and protecting these processes.

A focus on benefits of healthy perinatal physiologic processes aligns with the health system shift to providing higher-value care, addressing the unintended consequences of fee-for-service payments and improving health outcomes and experiences with wiser spending.

Increased use of this approach has the potential to preventively address troubling trends in maternal and newborn outcomes and persistent racial and other disparities in care and outcomes by mobilizing innate capacities for healthy childbearing processes and limiting use of consequential interventions that can be safely avoided. This approach is a way to provide more appropriate care to the majority of healthier, lower-risk women and newborns that often receives more specialized care, though such care may not be needed and may cause unintended harm.

The Blueprint identifies six widely accepted improvement strategies to transform maternity care and a series of specific recommendations within each strategy. Each recommendation is presented with immediate action steps to directly or indirectly increase access to healthy perinatal physiologic processes. The recommendations and action steps address many barriers to optimal care in the current maternity care system. The recommendations and action steps reflect unprecedented opportunities for innovation in the rapidly evolving health care environment. To realize system transformation, innovation must be accompanied by continuous evaluation and publication of results, refinement, and the scaling up and spreading of effective approaches.

This Blueprint’s six improvement strategies are as follows.

Click to learn more about the associated priority recommendations.

  1. Improve maternity care through innovative care delivery and payment systems and quality improvement initiatives. Read more »
  2. Advance performance measurement for high-value maternity care. Read more »
  3. Meaningfully engage all childbearing women and families. Read more »
  4. Transition to interprofessional education that supports team-based care for maternity care professionals. Read more »
  5. Foster an optimal maternity care workforce composition and distribution. Read more »
  6. Conduct priority research to advance the science of physiologic childbearing and its impact on maternal and child health outcomes. Read more »

The growing emphasis on the reliable provision of high-value maternity care creates unprecedented opportunities to ensure that most women and their fetuses/newborns have a healthy, uncomplicated labor, birth and transition in the days and weeks after birth. The present environment also offers opportunities to improve the care, experience and outcomes of women with health challenges by fostering healthy perinatal physiologic processes whenever safely possible.

It is important to build on the growing consensus and meaningful professional leadership that have occurred in recent years. Systemic, transformational change is essential for achieving a maternity care system in the United States that restores respect for the biological capacities and contributions of women and their fetuses/newborns and maximizes benefits of these capacities. This Blueprint was developed to move expeditiously toward this more balanced, coherent, preventive and complete maternity care system by offering specific improvement strategies, recommendations and action steps that are directly tied to the current health policy and practice environment.

Maternity care stakeholders – including policymakers, clinicians, administrators, health plans, employers, researchers, birth workers, advocates and women and families themselves – are deeply interested in improving quality and safety. We encourage all stakeholders to identify and implement the priority recommendations and action steps that they can advance – on their own and in collaboration with others. With this clear set of priorities, we can collectively transform care, improve outcomes and experiences, reduce disparities and rein in outlier costs. We face an exciting opportunity to achieve a full, high-performing maternity care system for all women, newborns and families.

Read the full report »

Read our fact sheet, A Blueprint for Improving Maternity Care in the United States: What Policymakers Can Do »

Watch the companion video about policies that address the U.S. maternal health crisis »

Read an open access Blueprint commentary published in Birth »