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Hoehn-Velasco L, Ross L, Phillippi RD, Niemczyk NA, Cammarano D, Calvin S, Phillippi JC, Alliman J, Stapleton SR, Wright J, Fisch S, Jolles D. Neonatal morbidity and mortality in birth centers in the United States 2018-2021: An observational study of low-risk birthing individuals. Birth 2024; 51:659-666. [PMID: 38778783 DOI: 10.1111/birt.12823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/26/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed. METHODS Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics. RESULTS The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p-value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p-value < 0.001). CONCLUSION Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers.
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Affiliation(s)
| | - Lisa Ross
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - R David Phillippi
- Department of Mathematics, Belmont University, Nashville, Tennessee, USA
| | - Nancy A Niemczyk
- Nurse-Midwife DNP Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dominic Cammarano
- Division of Gynecology, Reading Hospital, Reading, Pennsylvania, USA
| | - Steven Calvin
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Jill Alliman
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
- Frontier Nursing University, Lexington, Kentucky, USA
| | | | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Stanley Fisch
- Frontier Nursing University, Lexington, Kentucky, USA
| | - Diana Jolles
- Frontier Nursing University, Lexington, Kentucky, USA
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Arnedillo-Sánchez S, Suffo-Abouza JA, Carmona-Rodríguez MÁ, Morilla-Romero-de-la-Osa R, Arnedillo-Sánchez I. Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study. Nutrients 2024; 16:2116. [PMID: 38999864 PMCID: PMC11242974 DOI: 10.3390/nu16132116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/14/2024] Open
Abstract
Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.
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Affiliation(s)
- Socorro Arnedillo-Sánchez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (S.A.-S.); (J.A.S.-A.); (M.Á.C.-R.)
- Midwifery Training Unit, Department of Materno-Fetal Medicine, Genetics and Reproduction, Hospital Universitario Virgen del Rocio, 41013 Seville, Spain
- Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain
| | - Jose Antonio Suffo-Abouza
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (S.A.-S.); (J.A.S.-A.); (M.Á.C.-R.)
| | - Miguel Ángel Carmona-Rodríguez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (S.A.-S.); (J.A.S.-A.); (M.Á.C.-R.)
| | - Rubén Morilla-Romero-de-la-Osa
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (S.A.-S.); (J.A.S.-A.); (M.Á.C.-R.)
- Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Inmaculada Arnedillo-Sánchez
- School of Computer Science & Statistics, O’Reilly Institute, Trinity College Dublin, College Green 2, D02 PN40 Dublin, Ireland;
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Hill J, Zinsser LA, Wiemer A, Gross MM, Stoll K. Intrapartum time intervals and transfer of nulliparae from community births to maternity care units in Germany. Birth 2024; 51:39-51. [PMID: 37593788 DOI: 10.1111/birt.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Over one-third of nulliparae planning births either at home or in freestanding midwife-led birthing centers (community births) in high-income countries are transferred during labor. Perinatal data are reported each year in Germany for women planning community birth. So far, data sets have not been linked to describe time-related factors associated with nulliparous transfer to hospital. OBJECTIVES To describe the prevalence of referral for nulliparae and assess maternal and labor characteristics associated with intrapartum transfer. METHODS Perinatal data from 2010 to 2015 were linked (n = 26,115). Women were reviewed with respect to international eligibility criteria for community birth; 1997 women were excluded (7.6%). Descriptive statistics were reported; unadjusted and adjusted odds ratios with 95% confidence intervals (CI) tested the predictive effect of demographic and labor factors on rates of intrapartum transfer. RESULTS One in three nulliparous women (30.6%) were transferred to hospital. Compared with community births, transferred women were significantly more likely to experience longer time intervals during labor: from rupture of membranes (ROM) until birth lasting 5 to 18 h (OR 6.05, CI 5.53-6.61) and 19 to 24 h (OR 10.83, CI 9.45-12.41) compared to one to 4 h; and from onset of labor until birth 11 to 24 h (OR 6.72, CI 6.24-7.23) and 25 to 29 h (OR 26.62, CI 22.77-31.11) compared to one to 10 h. When entering all factors into the model, we found the strongest predictors of transfer to be fetal distress, longer time intervals between ROM until birth and onset of labor until birth. CONCLUSIONS Nulliparous transfer rates were similar to rates in other high-income countries; 94% of referrals were non-urgent. Time was found to be an independent risk factor for the transfer of nulliparae planning community birth.
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Affiliation(s)
- Janice Hill
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Midwifery Research, Institute of Health Sciences, Faculty of Medicine, University of Tübingen, Tubingen, Germany
| | - Laura A Zinsser
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Anke Wiemer
- Society for Quality in Out of Hospital Birth (QUAG), Hinter den Höfen 2, Storkow, Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Kathrin Stoll
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, Canada
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Hálfdánsdóttir B, Pálsdóttir SÓ, Ólafsdóttir ÓÁ, Swift EM. Normal birth rates before and after the merging of mixed-risk and low-risk maternity wards in Iceland: A retrospective cohort study on the impact of inter-professional preventative measures. Birth 2024; 51:152-162. [PMID: 37800388 DOI: 10.1111/birt.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND In 2014, the National University Hospital of Iceland (NUHI) merged a mixed-risk birth unit and a midwifery-led low-risk unit into one mixed-risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed-risk and low-risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services. METHODS A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2-year periods, 2012-2013 and 2015-2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi-square test. RESULTS The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates. CONCLUSIONS Interprofessional preventative measures, implemented alongside a mixed-risk and low-risk birth unit merger, can increase rates of births without interventions in a mixed-risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed-risk birth environment on the use of childbirth interventions and examine the long-term effects of preventative measures.
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Affiliation(s)
- Berglind Hálfdánsdóttir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Ólöf Ásta Ólafsdóttir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Emma Marie Swift
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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5
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Wallace J, Hoehn‐Velasco L, Tilden E, Dowd BE, Calvin S, Jolles DR, Wright J, Stapleton S. An alternative model of maternity care for low-risk birth: Maternal and neonatal outcomes utilizing the midwifery-based birth center model. Health Serv Res 2024; 59:e14222. [PMID: 37691323 PMCID: PMC10771911 DOI: 10.1111/1475-6773.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE To assess key birth outcomes in an alternative maternity care model, midwifery-based birth center care. DATA SOURCES The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019. STUDY DESIGN This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology. DATA COLLECTION Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439. PRINCIPAL FINDINGS Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001). CONCLUSIONS This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads.
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Affiliation(s)
- Jacqueline Wallace
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
| | - Lauren Hoehn‐Velasco
- Department of Economics, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Ellen Tilden
- Nurse‐Midwifery Department, School of NursingOregon Health and Science UniversityPortlandOregonUSA
- Department of OBGYN, School of MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Bryan E. Dowd
- Division of Health Policy and Management, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Steve Calvin
- Department of Obstetrics, Gynecology and Women's HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | | | - Jennifer Wright
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
| | - Susan Stapleton
- American Association of Birth Centers Research CommitteePerkiomenvillePennsylvaniaUSA
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6
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Hoehn-Velasco L, Jolles DR, Plemmons A, Silverio-Murillo A. Health outcomes and provider choice under full practice authority for certified nurse-midwives. JOURNAL OF HEALTH ECONOMICS 2023; 92:102817. [PMID: 37778146 DOI: 10.1016/j.jhealeco.2023.102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 05/15/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.
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Affiliation(s)
- Lauren Hoehn-Velasco
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, United States of America.
| | | | - Alicia Plemmons
- Department of General Business, West Virginia University, United States of America
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7
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Jolles DR, Niemczyk N, Hoehn Velasco L, Wallace J, Wright J, Stapleton S, Flynn C, Pelletier-Butler P, Versace A, Marcelle E, Thornton P, Bauer K. The birth center model of care: Staffing, business characteristics, and core clinical outcomes. Birth 2023; 50:1045-1056. [PMID: 37574794 DOI: 10.1111/birt.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/28/2023] [Accepted: 06/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Interest in expanding access to the birth center model is growing. The purpose of this research is to describe birth center staffing models and business characteristics and explore relationships to perinatal outcomes. METHODS This descriptive analysis includes a convenience sample of all 84 birth center sites that participated in the AABC Site Survey and AABC Perinatal Data Registry between 2012 and 2020. Selected independent variables include staffing model (CNM/CM or CPM/LM), legal entity status, birth volume/year, and hours of midwifery call/week. Perinatal outcomes include rates of induction of labor, cesarean birth, exclusive breastfeeding, birthweight in pounds, low APGAR scores, and neonatal intensive care admission. RESULTS The birth center model of care is demonstrated to be safe and effective, across a variety of staffing and business models. Outcomes for both CNM/CM and CPM/LM models of care exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding. Within the sample of medically low-risk multiparas, variations in clinical outcomes were correlated with business characteristics of the birth center, specifically annual birth volume. Increased induction of labor and cesarean birth, with decreased success breastfeeding, were present within practices characterized as high volume (>200 births/year). The research demonstrates decreased access to the birth center model of care for Black and Hispanic populations. CONCLUSIONS FOR PRACTICE Between 2012 and 2020, 84 birth centers across the United States engaged in 90,580 episodes of perinatal care. Continued policy development is necessary to provide risk-appropriate care for populations of healthy, medically low-risk consumers.
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Affiliation(s)
- Diana R Jolles
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
- Clinical Faculty, Frontier Nursing University, Hyden, Kentucky, USA
| | - Nancy Niemczyk
- Nurse-Midwife Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jacqueline Wallace
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Cynthia Flynn
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | | | | | - Ebony Marcelle
- Community of Hope, Washington, District of Columbia, USA
| | | | - Kate Bauer
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
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Niles PM, Baumont M, Malhotra N, Stoll K, Strauss N, Lyndon A, Vedam S. Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reprod Health 2023; 20:67. [PMID: 37127624 PMCID: PMC10152585 DOI: 10.1186/s12978-023-01584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. METHODS We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. RESULTS Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65-7.45), higher respect (aOR: 5.39, 95% CI: 3.72-7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10-0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66-4.27), respect (aOR: 4.15, 95% CI: 2.81-6.14), mistreatment (aOR: 0.20, 95% CI: 0.11-0.34), time spent (aOR: 8.06, 95% CI: 4.26-15.28). CONCLUSION Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.
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Affiliation(s)
- P. Mimi Niles
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Monique Baumont
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Nisha Malhotra
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Nan Strauss
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Audrey Lyndon
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Saraswathi Vedam
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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9
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Zhou P, Chen H, Zhang Y, Yao M. Nomogram based on the final antepartum ultrasound features before delivery for predicting failed spontaneous vaginal delivery in nulliparous women. Front Surg 2023; 9:1048866. [PMID: 36684290 PMCID: PMC9852332 DOI: 10.3389/fsurg.2022.1048866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background Accurate identification of nulliparous women with failed spontaneous vaginal delivery (SVD) is crucial to minimize the hazards associated with obstetrical intervention (OI). While abnormal labor progression can be identified with intrapartum ultrasonography, labor-related complications may be unavoidable due to the limited time window left to the obstetrician. Antepartum ultrasound enables sufficient obstetric planning. However, there is typically a longer gap between ultrasound assessment and delivery that often lowers the prediction accuracy compared to intrapartum ultrasonography. Objective In this study, antepartum ultrasound assessment was included to each fetal ultrasound examination after 36 weeks of gestation until the onset of labor. We aim to establish a nomogram to predict the likelihood of failed SVD in nulliparous women using the last antepartum ultrasound findings before labor beginning. Methods Of the 2,143 nulliparous women recruited, 1,373 were included in a training cohort and 770 in a validation cohort, based on their delivery date. Maternal and perinatal characteristics, as well as perinatal ultrasound parameters were collected. In the training cohort, the screened correlates of SVD failure were used to develop a nomogram for determining whether a nulliparous woman would experience SVD failure. This model was validated in both training and validation cohorts. Results SVD failure affected 217 nulliparous women (10.13%). In the training cohort, SVD failure was independently associated with BMI [odds ratio (OR) = 1.636], FHC (OR = 1.194), CL (OR = 1.398), and PCA (OR = 0.824) (all P < 0.05). They constituted a nomogram to estimate the individual risk of SVD failure. The model obtained clinical net benefits in both the training and validation cohorts and was validated to present strong discrimination and calibration. Conclusion The developed nomogram based on the last antepartum ultrasound findings may be helpful in avoiding OI and its related complications by assessing the likelihood of a failed SVD in nulliparous women.
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Affiliation(s)
- Ping Zhou
- Department of Gynecology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Han Chen
- Department of Ultrasound, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yang Zhang
- Department of Ultrasound, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,Correspondence: Yang Zhang Min Yao
| | - Min Yao
- Department of Pediatrics, , Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China,Correspondence: Yang Zhang Min Yao
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10
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Pappu NI, Öberg I, Byrskog U, Raha P, Moni R, Akhtar S, Barua P, Das SR, De S, Jyoti HJ, Rahman R, Sinha GR, Erlandsson K. The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students. PLoS One 2023; 18:e0271867. [PMID: 37036838 PMCID: PMC10085017 DOI: 10.1371/journal.pone.0271867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.
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Affiliation(s)
| | - Ida Öberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pronita Raha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ratna Moni
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shaheen Akhtar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Priti Barua
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sujata Rani Das
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shipra De
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Rezaur Rahman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gita Rani Sinha
- School of Health and Welfare, Dalarna University, Falun, Sweden
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11
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Medina ET, Mouta RJO, Carmo CND, Filha MMT, Leal MDC, Gama SGND. [Good practices, interventions, and results: a comparative study between a birthing center and hospitals of the Brazilian Unified National Health System in the Southeastern Region, Brazil]. CAD SAUDE PUBLICA 2023; 39:e00160822. [PMID: 37075342 DOI: 10.1590/0102-311xpt160822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/02/2023] [Indexed: 04/21/2023] Open
Abstract
This study aims to compare obstetric care in a birthing center and in hospitals of the Brazilian Unified National Health System (SUS) considering good practices, interventions, and maternal and perinatal results in the Southeast Region of Brazil. A cross-sectional study was conducted with comparable retrospective data from two studies on labor and birth. A total of 1,515 puerperal women of usual risk of birthing centers and public hospitals in the Southeast region were included. Propensity score weighting was used to balance the groups according to the following covariates: age, skin-color, parity, membrane integrity, and cervix dilation at hospitalization. Logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between the place of birth and outcomes. In birthing centers, compared to hospitals, the puerperal woman had a higher chance of having a companion (OR = 86.31; 95%CI: 29.65-251.29), eating or drinking (OR = 862.38; 95%CI: 120.20-6,187.33), walking around (OR = 7.56; 95%CI: 4.65-12.31), using non-pharmacological methods for pain relief (OR = 27.82; 95%CI: 17.05-45.40), being in an upright position (OR = 252.78; 95%CI: 150.60-423.33), and a lower chance of using oxytocin (OR = 0.22; 95%CI: 0.16-0.31), amniotomy (OR = 0.01; 95%CI: 0.01-0.04), episiotomy (OR = 0.01; 95%CI: 0.00-0.02), and Kristeller maneuvers (OR = 0.01; 95%CI: 0.00-0.02). Also, in birthing centers the newborn had a higher chance of exclusive breastfeeding (OR = 1.84; 95%CI: 1.16-2.90) and a lower chance of airway (OR = 0.24; 95%CI: 0.18-0.33) and gastric aspiration (OR = 0.15; 95%: 0.10-0.22). Thus, birthing centers offers a greater supply of good practices and fewer interventions in childbirth and birth care, with more safety and care without influence on the outcomes.
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Affiliation(s)
| | | | | | | | - Maria do Carmo Leal
- Vice-Presidência de Ensino, Informação e Comunicação, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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12
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Danhausen K, Diaz HL, McCain MA, McGinigle M. Strengthening Interprofessional Collaboration to Improve Transfers Between a Freestanding Birth Center and an Academic Medical Center. J Midwifery Womens Health 2022; 67:753-758. [PMID: 36433687 DOI: 10.1111/jmwh.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
The number of individuals choosing to give birth in a freestanding birth center has doubled since 2004. As many as half of all pregnant persons planning for a birth center birth ultimately develop medical complications and are unable to give birth outside of the hospital. Integrating birth centers into their regional perinatal health care system optimizes outcomes by establishing predetermined pathways for antepartum and intrapartum transfers of care and facilitates ongoing communication and cooperation among clinicians. The Vanderbilt Birth Center is a freestanding birth center that is operated by an academic medical center and partners with a hospital-based midwifery practice that cares for patients transferring from the birth center. Since the inception of the birth center in 2015, the entire perinatal team has worked to improve the process and experience of patient transfer from birth center to hospital care. This article will present strategies implemented through the ongoing collaboration between birth center and hospital health care providers. These include adopting a shared electronic health record, clinical practice guidelines that align across birth sites, preparing birth center patients prenatally for the possibility hospital transfer, the presentation of a united team across birth sites, clear and widely disseminated communication pathways for hospital admission and patient handoff, and ongoing opportunities for interteam communication, collaboration, and education. These strategies may benefit similar midwifery practice models as they seek to partner with larger health care systems and improve the transfer experience for their patients.
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Affiliation(s)
| | - Hannah L Diaz
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Manola A McCain
- Vanderbilt University School of Nursing, Nashville, Tennessee
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13
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Zephyrin L, Johnson K. Optimizing Medicaid Extended Postpartum Coverage to Drive Health Care System Change. Womens Health Issues 2022; 32:536-539. [PMID: 36117077 DOI: 10.1016/j.whi.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
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Episiotomy for Medical Indications during Vaginal Birth-Retrospective Analysis of Risk Factors Determining the Performance of This Procedure. J Clin Med 2022; 11:jcm11154334. [PMID: 35893429 PMCID: PMC9368956 DOI: 10.3390/jcm11154334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia's Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76-7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90-3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52-3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52-3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62-1.93), male gender (OR = 1.10; 95% CI: 1.02-1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01-1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37-0.51) and mulitpara (OR = 0.31; 95% CI: 0.27-0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.
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Ulrich S. Scaling the Strong Start Birth Centers: Promoting Equitable Maternity Outcomes. Am J Public Health 2022; 112:712-715. [PMID: 35298235 PMCID: PMC9010914 DOI: 10.2105/ajph.2022.306802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Suzan Ulrich
- Suzan Ulrich is with the School of Nursing at George Washington University, Washington, DC
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16
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Welch L, Branch Canady R, Harmell C, White N, Snow C, Kane Low L. We Are Not Asking Permission to Save Our Own Lives: Black-Led Birth Centers to Address Health Inequities. J Perinat Neonatal Nurs 2022; 36:138-149. [PMID: 35476768 DOI: 10.1097/jpn.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE While favorable outcomes of birth centers are documented, Black-led birth centers and maternal health models are rarely highlighted. Such disparities are manifestations of institutional racism. A nascent body of literature suggests that culturally affirming care provided by Black-led birth centers benefit all birthing people-regardless of race. Birth Detroit is one such maternal health model led by Black women that offers a justice response to inequitable care options in Black communities. METHODS This article describes a departure from traditional White supremacist research models that privilege quantitative outcomes to the exclusion of iterative processes, lived experiences, and consciousness-raising. A community organizing approach to birth center development led by Black women and rooted in equity values of safety, love, trust, and justice is outlined. RESULTS Birth Detroit is a Black-led, community-informed model that includes integration of evidence-based approaches to improving health outcomes and that embraces community midwifery prenatal care and a strategic trajectory to open a birth center in the city of Detroit. CONCLUSION Birth Detroit demonstrates the operationalization of a Black feminist standpoint, lifts up the power of communities to lead in their own care, and offers a blueprint for action to improve inequities and maternal-infant health in Black communities.
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Affiliation(s)
- Leseliey Welch
- Birth Detroit, Detroit, Michigan (Mss Welch, Harmell, White, and Snow); Birth Center Equity, Boston, Massachusetts (Ms Welch); Michigan Public Health Institute, Lansing (Dr Canady); Public Health, Michigan State University, Lansing (Dr Canady); and School of Nursing, Women's and Gender Studies, Obstetrics and Gynecology, University of Michigan, Ann Arbor (Dr Kane Low)
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Neerland CE, Skalisky AE. A Qualitative Study of US Women's Perspectives on Confidence for Physiologic Birth in the Birth Center Model of Prenatal Care. J Midwifery Womens Health 2022; 67:435-441. [PMID: 35246924 DOI: 10.1111/jmwh.13349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to increase understanding of the components of the US birth center model of prenatal care and how the birth center prenatal care model contributes to birthing people's confidence for physiologic childbirth. METHODS This was a qualitative descriptive study using semistructured interviews with individuals who gave birth in freestanding birth centers. Birthing people were recruited from freestanding birth centers in a Midwestern US state and were between the ages of 18 and 42, were English-speaking, and had experienced a birth center birth within the previous 6 months. Interviews were transcribed and analyzed using Glaser's constant comparative method. RESULTS Twelve women who gave birth in birth centers, representing urban and rural settings, participated. Four core categories were identified encompassing the components of birth center prenatal care and how the birth center model contributes to women's confidence for physiologic birth: birth center culture and processes, midwifery model of care within the birth center, internal influences, and outside influences. DISCUSSION Women who gave birth in birth centers believed that the birth center culture and environment, the midwifery model of care in the birth center, internal influences including the belief that birth is a normal physiologic process, and outside influences including family support and positive birth stories contributed to their confidence for physiologic birth.
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18
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Levine A, Souter V, Sakala C. Are perinatal quality collaboratives collaborating enough? How including all birth settings can drive needed improvement in the United States maternity care system. Birth 2022; 49:3-10. [PMID: 34698401 PMCID: PMC9298427 DOI: 10.1111/birt.12600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Audrey Levine
- Smooth TransitionsFoundation for Health Care QualitySeattleWashingtonUSA
| | - Vivienne Souter
- Obstetrical Care Outcomes Assessment ProgramSeattleWashingtonUSA,Department of Health ServicesSchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Carol Sakala
- National Partnership for Women and FamiliesWashingtonDistrict of ColumbiaUSA
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19
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Ross L, Jolles D, Hoehn-Velasco L, Wright J, Bauer K, Stapleton S. Salary and Workload of Midwives Across Birth Center Practice Types and State Regulatory Structures. J Midwifery Womens Health 2022; 67:244-250. [PMID: 35191600 DOI: 10.1111/jmwh.13331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Expansion of the midwifery-led birth center model of care is one pathway to improving maternal and newborn health. There are a variety of practice types among birth centers and a range of state regulatory structures of midwifery practice across the United States. This study investigated how those variations relate to pay and workload for midwives at birth centers. METHODS Data from the American Association of Birth Centers Practice Survey and the Bureau of Labor Statistics' report on occupational employment and wage statistics were analyzed to explore how midwife salaries and workload at birth centers compare within and beyond the birth center model. RESULTS Survey results from 161 birth centers across the United States demonstrate wide variation in nurse-midwife salaries and are inconsistent with nurse-midwife salaries across all settings as reported by the Bureau of Labor Statistics. The reported number of hours worked by midwives within the birth center model is high. Salaries of midwives who work in birth center-only practices were consistently lower than salaries of midwives who worked in blended birth center and hospital practices, independent of the midwife's level of experience, geographic region of the country, and state regulatory structure. DISCUSSION Further research is needed to understand how to bring salaries and workload for midwives at birth centers into alignment with national averages.
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Affiliation(s)
- Lisa Ross
- American Association of Birth Centers, Perkiomenville, Pennsylvania
| | - Diana Jolles
- Frontier Nursing University, Versailles, Kentucky
| | | | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania
| | - Kate Bauer
- American Association of Birth Centers, Perkiomenville, Pennsylvania
| | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania
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Alliman J, Bauer K, Williams T. Freestanding Birth Centers: An Evidence-Based Option for Birth. J Perinat Educ 2022; 31:8-13. [PMID: 35165499 PMCID: PMC8827343 DOI: 10.1891/jpe-2021-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Every childbearing person has the right to learn about all options for perinatal care provider and birth setting. To ensure an informed decision about their preferred birth plan, information should be provided either preconceptionally or in early pregnancy. Personal preferences and risk status should be considered in decision-making. Numbers of births in birth centers have doubled over past decade to almost 20,000 births per year. The evidence shows that childbearing people who participate in birth center care, even if they have only birth center prenatal care, experience better outcomes including lower rates of preterm birth, low birth weight births, and cesarean birth, and higher rates of breastfeeding when compared to people with similar risk profiles who receive typical perinatal care.
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Affiliation(s)
- Jill Alliman
- Frontier Nursing University and American Association of Birth Centers, Sweetwater, Tennessee
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21
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Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation 2021; 144:e251-e269. [PMID: 34493059 DOI: 10.1161/cir.0000000000001000] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association's mission "to be a relentless force for longer, healthier lives," this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers' lives.
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Preis H, Mahaffey B, Lobel M. The role of pandemic-related pregnancy stress in preference for community birth during the beginning of the COVID-19 pandemic in the United States. Birth 2021; 48:242-250. [PMID: 33677838 PMCID: PMC8250474 DOI: 10.1111/birt.12533] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. METHODS This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress. RESULTS Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. DISCUSSION Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.
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Affiliation(s)
- Heidi Preis
- Department of PsychologyStony Brook UniversityStony BrookNew YorkUSA
- Department of PediatricsRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral HealthRenaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Marci Lobel
- Department of PsychologyStony Brook UniversityStony BrookNew YorkUSA
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Sanders SA, Niemczyk NA, Burke JG, McCarthy AM, Terry MA. Exploring Why Birth Center Clients Choose Hospitalization for Labor and Birth. Nurs Womens Health 2021; 25:30-42. [PMID: 33453158 DOI: 10.1016/j.nwh.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/03/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify demographic and clinical factors associated with birth center clients electing hospitalization for labor and birth and to explore the timing and rationale for elective hospitalization via health records. DESIGN A secondary analysis of multiyear data from a quality assurance project at a single birth center. We compared two subsamples-birth center preference group and hospital preference group-and described the apparent rationale for transfers among clients in the latter group. SETTING A single freestanding birth center where all midwives have admitting privileges at a local hospital and can accompany labor transfers. PARTICIPANTS All cases included in the analytic sample represent women with low-risk pregnancies who were eligible for birth center birth. The birth center preference group represents clients planning to give birth at the center, and the hospital preference group consists of clients who elected for hospitalization. MEASUREMENTS Relevant demographic and clinical information was provided for the entire analytic sample and was matched with available data collected systematically by birth center staff via chart review. The data set also included anonymous responses to an e-mailed questionnaire from clients identified by birth center staff. RESULTS Approximately 56.1% (N = 1,155) of the cases in the data set were eligible for comparative analysis. The birth center preference and hospital preference groups included 899 (77.8%) and 256 (22.2%) individuals, respectively. In the hospital preference group, Black clients (n = 23), those who were publicly insured (n = 49), and primiparas (n = 101) were significantly overrepresented. Chart review data and questionnaire responses highlighted insurance restrictions, family preferences, pain relief options, and postpartum care as influential factors among members of the hospital preference subsample. CONCLUSION The present analysis shows associations between certain individual characteristics and elective hospitalization during labor for birth center clients. Health record data and questionnaire responses indicated a variety of reasons for electing hospitalization, illustrating the complexity of clients' decision-making during pregnancy and birth.
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Kim YM. 2020 Year of the nurse and the midwife: a call for strengthening midwifery in response to South Korea's ultra-low birth rate. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2020; 26:255-259. [PMID: 36312305 PMCID: PMC9328611 DOI: 10.4069/kjwhn.2020.12.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022] Open
Abstract
Along with the low birth rate in Korea, the aging of mothers is progressing very rapidly. Recent studies have reported that the obstetric infrastructure is crumbling due to the accelerating closures of obstetric medical institutions resulting from the low birth rate and low reimbursement rates for obstetric procedures. The number of birth centers has also decreased, but women's interest in natural birth has actually increased, such that deliveries at birth centers now account for 11.8% of deliveries in obstetric clinics. In the Netherlands, Japan, and the United Kingdom, initiatives to promote natural birth through care provided by midwives increased the rate of natural births, decreased the number of cesarean sections, and lowered the rate of postpartum complications. In light of these examples, South Korea should also encourage natural delivery by midwives. A national support system for midwife applicants is necessary, and the requirements for institutions that train midwives should be revised. Independent birth centers should have emergency prescription privileges, and women should be given the choice to have a natural delivery by creating birth centers within hospitals.
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Affiliation(s)
- Yun Mi Kim
- College of Nursing, Gachon University, Incheon, Korea
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Jevitt CM, Stapleton S, Deng Y, Song X, Wang K, Jolles DR. Birth Outcomes of Women with Obesity Enrolled for Care at Freestanding Birth Centers in the United States. J Midwifery Womens Health 2020; 66:14-23. [PMID: 33377279 PMCID: PMC7986149 DOI: 10.1111/jmwh.13194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/27/2022]
Abstract
Introduction Current US guidelines for the care of women with obesity generalize obesity‐related risks to all women regardless of overall health status and assume that birth will occur in hospitals. Perinatal outcomes for women with obesity in US freestanding birth centers need documentation. Methods Pregnancies recorded in the American Association of Birth Centers Perinatal Data Registry were analyzed (n = 4,455) to form 2 groups of primiparous women (n = 964; 1:1 matching of women with normal body mass indices [BMIs] and women with obese BMIs [>30]), using propensity score matching to address the imbalance of potential confounders. Groups were compared on a range of outcomes. Differences between groups were evaluated using χ2 test for categorical variables and Student's t test for continuous variables. Paired t test and McNemar's test evaluated the differences among the matched pairs. Results The majority of women with obese BMIs experienced uncomplicated perinatal courses and vaginal births. There were no significant differences in antenatal complications, proportion of prolonged pregnancy, prolonged first and second stage labor, rupture of membranes longer than 24 hours, postpartum hemorrhage, or newborn outcomes between women with obese BMIs and normal BMIs. Among all women with intrapartum referrals or transfers (25.3%), the primary indications were prolonged first stage or second stage (55.4%), inadequate pain relief (14.8%), client choice or psychological issue (7.0%), and meconium (5.3%). Primiparous women with obesity who started labor at a birth center had a 30.7% transfer rate and an 11.1% cesarean birth rate. Discussion Women with obese BMIs without medical comorbidity can receive safe and effective midwifery care at freestanding birth centers while anticipating a low risk for cesarean birth. The risks of potential, obesity‐related perinatal complications should be discussed with women when choosing place of birth; however, pregnancy complicated by obesity must be viewed holistically, not simply through the lens of obesity.
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Affiliation(s)
- Cecilia M Jevitt
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Xuemei Song
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Diana R Jolles
- American Association of Birth Centers, Perkiomenville, Pennsylvania
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Reszel J, Weiss D, Darling EK, Sidney D, Van Wagner V, Soderstrom B, Rogers J, Holmberg V, Peterson WE, Khan BM, Walker MC, Sprague AE. Client Experience with the Ontario Birth Center Demonstration Project. J Midwifery Womens Health 2020; 66:174-184. [PMID: 33336882 PMCID: PMC8247041 DOI: 10.1111/jmwh.13164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In 2014, 2 new freestanding midwifery-led birth centers opened in Ontario, Canada. As one part of a larger mixed-methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intending to give birth at home or in hospital. METHODS We conducted a cross-sectional survey of women cared for by midwives with admitting privileges at one of the 2 birth centers. Consenting women received the survey 3 to 6 weeks after their due date. We stratified the analysis by intended place of birth at the beginning of labor, regardless of where the actual birth occurred. One composite indicator was created (Composite Satisfaction Score, out of 20), and statistical significance (P < .05) was assessed using one-way analysis of variance. Responses to the open-ended questions were reviewed and grouped into broader categories. RESULTS In total, 382 women completed the survey (response rate 54.6%). Half intended to give birth at a birth center (n = 191). There was a significant difference on the Composite Satisfaction Scores between the birth center (19.4), home (19.5), and hospital (18.9) groups (P < .001). Among women who intended to give birth in a birth center, scores were higher in the women admitted to the birth center compared with those who were not (P = .037). Overall, women giving birth at a birth center were satisfied with the learners present at their birth, the accessibility of the centers, and the physical amenities, and they had suggestions for minor improvements. DISCUSSION We found positive experiences and high satisfaction among women receiving midwifery care, regardless of intended place of birth. Women admitted to the birth centers had positive experiences with these new centers; however, future research should be planned to reassess and further understand women's experiences.
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Affiliation(s)
- Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,CHEO Research Institute, CHEO, Ottawa, Ontario, Canada
| | - Deborah Weiss
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dana Sidney
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Vicki Van Wagner
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada
| | - Bobbi Soderstrom
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada.,Association of Ontario Midwives (AOM), Toronto, Ontario, Canada
| | - Judy Rogers
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada
| | - Vivian Holmberg
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Wendy E Peterson
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Bushra M Khan
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Mark C Walker
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,CHEO Research Institute, CHEO, Ottawa, Ontario, Canada
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Song JY, Park YJ. [Opening Status of the Korea Midwifery Birthing Centers and Development of Midwifery Practice Guideline]. J Korean Acad Nurs 2020; 50:583-598. [PMID: 32895344 DOI: 10.4040/jkan.20032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was to investigate the operational status of the midwifery birthing centers (MBCs) and midwives' job status (Phase 1) and to develop midwifery practice guidelines (MPG) (Phase 2) in Korea. METHODS In the first phase, the subjects were 15 midwives who operated 11 of 14 MBCs that were opened as of August 2018. The questionnaire consisted of items to measure the operational status of the MBC and midwives' job status. In the second phase, the MPG was developed from literature review, interviews with five midwives opening their MBCs, surveys with 74 midwives, and a validity evaluation conducted by seven experts. RESULTS The distribution of operating MBCs was five in Gyunggi-do, two each in Seoul and Incheon, one each in Busan, Chungcheongbuk-do, Gyeongsangbuk-do, Gyeongsangnam-do and Jeju-do. The mean age of midwives was 54.3 and all were female. In 2017, a total of 762 births including 81 homebirths were performed by midwives. The job performance was highest in the order of neonatal care 3.81, childbirth care 3.56, and postpartal care 3.53, respectively. The MPG included seven areas of prenatal care, childbirth care, postpartal care, neonatal care, primary health care, law/ethics, and administration, with 56 tasks and 166 task elements. CONCLUSION This study provides the valid basic data for the operational status of the MBC and the midwives' job status. The MPG describes the midwife's job and may be used as basic data for preparing policies for the development of midwifery practice in Korea.
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Dubay L, Hill I, Garrett B, Blavin F, Johnston E, Howell E, Morgan J, Courtot B, Benatar S, Cross-Barnet C. Improving Birth Outcomes And Lowering Costs For Women On Medicaid: Impacts Of ‘Strong Start For Mothers And Newborns’. Health Aff (Millwood) 2020; 39:1042-1050. [DOI: 10.1377/hlthaff.2019.01042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lisa Dubay
- Lisa Dubay is a senior fellow in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Ian Hill
- Ian Hill is a senior fellow in the Health Policy Center, Urban Institute
| | - Bowen Garrett
- Bowen Garrett is a senior fellow in the Health Policy Center, Urban Institute
| | - Fredric Blavin
- Fredric Blavin is a principal research associate in the Health Policy Center, Urban Institute
| | - Emily Johnston
- Emily Johnston is a research associate in the Health Policy Center, Urban Institute
| | - Embry Howell
- Embry Howell is a nonresident fellow in the Health Policy Center, Urban Institute
| | - Justin Morgan
- Justin Morgan is a PhD student at the Harvard T. H. Chan School of Public Health. At the time this research was conducted, he was a research analyst at the Urban Institute
| | - Brigette Courtot
- Brigette Courtot is a principal research associate in the Health Policy Center, Urban Institute
| | - Sarah Benatar
- Sarah Benatar is a principal research associate in the Health Policy Center, Urban Institute
| | - Caitlin Cross-Barnet
- Caitlin Cross-Barnet is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
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Alliman J, Bauer K. Next Steps for Transforming Maternity Care: What Strong Start Birth Center Outcomes Tell Us. J Midwifery Womens Health 2020; 65:462-465. [PMID: 32277571 PMCID: PMC7496471 DOI: 10.1111/jmwh.13084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kate Bauer
- American Association of Birth Centers, Perkiomenville, Pennsylvania
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Seijmonsbergen-Schermers AE, Zondag DC, Nieuwenhuijze M, van den Akker T, Verhoeven CJ, Geerts CC, Schellevis FG, de Jonge A. Regional variations in childbirth interventions and their correlations with adverse outcomes, birthplace and care provider: A nationwide explorative study. PLoS One 2020; 15:e0229488. [PMID: 32134957 PMCID: PMC7058301 DOI: 10.1371/journal.pone.0229488] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. METHODS In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations. FINDINGS Intrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. CONCLUSIONS Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dirkje C. Zondag
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine J. Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Caroline C. Geerts
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - François G. Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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A Collaborative Model of a Community Birth Center and a Tertiary Care Medical Center. Obstet Gynecol 2020; 135:696-702. [DOI: 10.1097/aog.0000000000003723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Implementing Screening Guidelines for Preeclampsia Prevention in a Birth Center: A Quality Improvement Project. J Perinat Neonatal Nurs 2020; 34:324-329. [PMID: 32804877 DOI: 10.1097/jpn.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the project was to identify women at risk for developing preeclampsia who present for birth center care in order to initiate preventative treatment and retain them within the birth center practice. Birth center patients with preeclampsia disqualify for birth center care requiring hospital transfer. The target population consisted of pregnant women choosing birth center care with certified nurse midwives. Quality improvement method was utilized. Over 5-weeks, patients with 12 to 28 weeks' gestation were screened for preeclampsia risk factors; patients with high risk for preeclampsia initiated low-dose aspirin (LDA). All patients were evaluated for preeclampsia diagnosis up to 2 weeks postpartum. Outcomes were evaluated through chart audits. Screening for preeclampsia risk significantly increased LDA use. Preeclampsia screening did not statistically reduce incidences of preeclampsia but did show a moderate reduction. Use of LDA did not statistically reduce preeclampsia diagnoses but had a large reduction effect. Screening for preeclampsia in birth center patients results in increased use of LDA and potentially decreased rates of hospital transfer. Implementing preeclampsia screening is cost-effective and allows for increased patient retention.
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Rocca-Ihenacho L, Alonso C. Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic. ACTA ACUST UNITED AC 2020. [DOI: 10.35500/jghs.2020.2.e4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Mubeen K, Jan R, Sheikh S, Lakhani A, Badar SJ. Maternal and newborn outcomes of care from community midwives in Pakistan: A retrospective analysis of routine maternity data. Midwifery 2019; 79:102553. [PMID: 31622848 DOI: 10.1016/j.midw.2019.102553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The study aimed to determine the maternal and newborn outcomes of Community Midwives' (CMWs') services in Pakistan as recorded in the provincial Management Information System (MIS) of the government's Maternal Newborn and Child Health (MNCH) program of Sindh province. METHODOLOGY A descriptive retrospective design was used to examine the monthly reports of CMWs, stored in the MNCH-MIS, for the period of January 2013 to December 2015. A total of 200 CMWs were randomly selected from 23 districts of the Sindh province. The outcomes of the CMWs' services were analyzed, using descriptive statistics. RESULTS The analysis of data of 23 districts revealed that a total of 103,836 antenatal care were attended by 200 CMWs who were selected for the study. For intranatal care, 23,296 cases were registered, of which 78.3% (n = 18, 233) returned to these CMWs at the time of delivery. During the period, 17,849 were live births. The still birth rate was calculated to be 13.4/1000, the abortion rate was 7.3 per 1000 pregnant women, newborn mortality rate was 12.4/1000 live births, and the maternal mortality ratio was 142.5/100,000 live births. Moreover, the low birth weight newborns were 9% of the total live births. CONCLUSION This study indicates that although the outcomes for CMWs are better than for some other cadres in Pakistan, they are still inadequate compared to midwives trained to the international standards. The outcomes presented in this study are in line with the challenges of CMWs survival reported in the earlier studies. This strongly indicate need for improvement in CMWs pre-service and in-service education to meet the international quality standards set by ICM.
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Affiliation(s)
- Kiran Mubeen
- Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan.
| | - Rafat Jan
- Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan.
| | - Sana Sheikh
- Aga Khan University, Research Department, Obstetric and Gynecology.
| | - Arusa Lakhani
- Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan.
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Oliveira TCDMD, Pereira ALDF, Penna LHG, Rafael RDMR, Pereira AV. Adequacy of prenatal assistance in birth houses and causes associated with hospital transfers. ACTA ACUST UNITED AC 2019; 40:e20180419. [PMID: 31576969 DOI: 10.1590/1983-1447.2019.20180419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the adequacy of prenatal care in a Birth Center and the causes associated with maternal and newborn transfers to the hospital. METHODS Cross-sectional study of the care provided at the only Birth Center in Rio de Janeiro, from 2009 to 2014. Statistical analyzes were based on the χ2 test and Prevalence Ratio (PR). RESULTS Suitable prenatal care was predominant (42.8%) and there was no association (p = 0.55) with the transfers. Maternal transfer is caused by the ruptured amniotic sac (PR = 2.09, 95% CI 1.62-2.70) and altered fetal heart rates (PR = 3.06, 95% CI, 2.13-4.39). Newborn transfers are associated with the presence of meconium in the amniotic fluid (PR = 2.40, 95% CI 1.30-4.43); Apgar below 7 (PR = 5.33, 95% CI 2.65-10.73); and ventilatory assistance at birth (PR = 9.41, 95% CI 5.52-16.04). CONCLUSION Complications during intrapartum care are the causes associated with transfers.
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Affiliation(s)
- Tamara Cristina da Matta de Oliveira
- Universidade do Estado do Rio de Janeiro (UERJ). Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Rio de Janeiro, Rio de Janeiro. Brasil
| | - Adriana Lenho de Figueiredo Pereira
- Universidade do Estado do Rio de Janeiro (UERJ). Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Rio de Janeiro, Rio de Janeiro. Brasil
| | - Lucia Helena Garcia Penna
- Universidade do Estado do Rio de Janeiro (UERJ). Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Rio de Janeiro, Rio de Janeiro. Brasil
| | - Ricardo de Mattos Russo Rafael
- Universidade do Estado do Rio de Janeiro (UERJ). Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Rio de Janeiro, Rio de Janeiro. Brasil
| | - Audrey Vidal Pereira
- Universidade Federal Fluminense (UFF), Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brasil
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Alliman J, Stapleton SR, Wright J, Bauer K, Slider K, Jolles D. Strong Start in birth centers: Socio-demographic characteristics, care processes, and outcomes for mothers and newborns. Birth 2019; 46:234-243. [PMID: 31102319 PMCID: PMC6594238 DOI: 10.1111/birt.12433] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/10/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND A recent Center for Medicare and Medicaid Innovation report evaluated the four-year Strong Start for Mothers and Newborns Initiative, which sought to improve maternal and newborn outcomes through exploration of three enhanced, evidence-based care models. This paper reports the socio-demographic characteristics, care processes, and outcomes for mothers and newborns engaged in care with American Association of Birth Centers (AABC) sites. METHODS The authors examined data for 6424 Medicaid or Children's Health Insurance Program (CHIP) beneficiaries in birth center care who gave birth between 2013 and 2017. Using data from the AABC Perinatal Data Registry™, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Comparisons are made between outcomes in the AABC sample and national data during the study period. RESULTS Childbearing mothers enrolled at AABC sites had diverse socio-behavioral risk factors similar to the national profile. The AABC sites exceeded national quality benchmarks for low birthweight (3.28%), preterm birth (4.42%), and primary cesarean birth (8.56%). Racial disparities in perinatal indicators were present within the Strong Start sample; however, they were at narrower margins than in national data. The enhanced model of care was notable for use of midwifery-led prenatal, labor, and birth care and decreased hospital admission. CONCLUSIONS Birth center care improves population health, patient experience, and value. The model demonstrates the potential to decrease racial disparity and improve population health. Reduction of regulatory barriers and implementation of sustainable reimbursement are warranted to move the model to scale for Medicaid beneficiaries nationwide.
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Affiliation(s)
| | | | - Jennifer Wright
- American Association of Birth CentersPerkiomenvillePennsylvania
| | - Kate Bauer
- American Association of Birth CentersPerkiomenvillePennsylvania
| | - Kate Slider
- American Association of Birth CentersPerkiomenvillePennsylvania
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Abstract
The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal settlements are grim. Insufficient uptake of antenatal care, lack of skilled birth attendants and poor-quality care contribute to maternal mortality rates in informal settlements that far outpace wealthier urban neighborhoods (Chant and McIlwaine (2016)). In response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate care in high resource settings (Stapleton et al. J Midwifery Women's Health 58(1):3-14, 2013; Hodnett et al. Cochrane Database Syst Rev CD000012, 2012; Brocklehurst et al. BMJ 343:d7400, 2011). In this paper, three case studies are described that support the use of this model in low resource, urban settings.
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Abstract
ABSTRACT Objective: to analyse the perineal outcomes in childbirth and post-partum perineal care in a freestanding birth centre. Method: a cross-sectional study, with data collection performed in the women’s birth records forms from Casa Angela, a freestanding birth centre, São Paulo, Brazil, in 2016-2017 (n=415). The following data was analysed: occurrence and perineal tear degree; maternal, neonatal and birth care-related variables; perineal suture prevalence; complications in wound healing and natural methods on perineal care. Data were subjected to descriptive, inferential and multiple analyses. Results: in 11.8% of women, the perineum was kept intact, 61.9% had spontaneous first-degree tear and 26.3% had second-degree tear. The variables related to the occurrence and higher spontaneous degree tears were maternal age and second period of childbirth >2 hours. The protective factors against the occurrence and higher degree tears were number of previous vaginal childbirths and maternal position different from vertical during childbirth. Perineal suture was performed in 16.0% and 70.6% of women with spontaneous first- and second-degree tears, respectively. The main perineal complications after birth were edema (53.6%) and pain (29.4%); and the perineal suture increased the chance for these complications (OR=2.5; 95%CI 1.5-4.3). Perineum icepack compress was used in 53.8% of women during post-partum period. Conclusion: maternal and health-care related factors were associated to the prevalence and degree of spontaneous perineal tear. First-degree spontaneous perineal tears were prevalent and sutured in a low number of women. There were more complications in the wound healing process when the perineal suture was performed, regardless the tear degree. The number of natural methods in post-partum perineal care was higher than the use of medicines.
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Scarf VL, Rossiter C, Vedam S, Dahlen HG, Ellwood D, Forster D, Foureur MJ, McLachlan H, Oats J, Sibbritt D, Thornton C, Homer CSE. Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery 2018; 62:240-255. [DOI: 10.1016/j.midw.2018.03.024] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
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Stephenson-Famy A, Masarie KS, Lewis A, Schiff MA. What are the risk factors associated with hospital birth among women planning to give birth in a birth center in Washington State? Birth 2018; 45:130-136. [PMID: 29251376 DOI: 10.1111/birt.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have evaluated risk factors associated with hospital birth among women planning to give birth in a birth center in the United States. This study describes the obstetrical risk factors for hospital birth among women intending to deliver in a birth center in Washington State. METHODS We performed a retrospective cohort study of Washington State birth certificate data for women with singleton, term pregnancies planning to give birth at a birth center from 2004 to 2011. We assessed risk factors for hospital birth including demographic, obstetrical, and medical characteristics. We used multivariable logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between risk factors and hospital birth. RESULTS Among the 7118 women planning to give birth at a birth center during the study period, 7% (N = 501) had a hospital birth, and 93% delivered at a birth center (N = 6617). The strongest risk factors for hospital transfer included nulliparity (OR 7.2 [95% CI 5.3-9.8]), maternal age >40 years (OR 3.7 [95% CI 2.1-6.7]), inadequate prenatal care (OR 3.7 [95% CI 2.7-5.0]), body mass index ≥30 (OR 2.1 [95% CI 1.6-3.0]), government health insurance (OR 9.3 [95% CI 5.0-17.1]), and hypertension (10.1 [95% CI 5.7-18.1]). Among nulliparous women, all of these demographic and obstetrical factors remained strongly associated with hospital birth. CONCLUSIONS This information may be useful for counseling women who plan a birth center birth about the risk of hospital birth.
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Affiliation(s)
- Alyssa Stephenson-Famy
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine at University of Washington School of Medicine, Seattle, WA, USA
| | - Kaitlin S Masarie
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine at University of Washington School of Medicine, Seattle, WA, USA
| | - Ali Lewis
- University of Washington Medicine Northwest Hospital, Seattle, WA, USA
| | - Melissa A Schiff
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Department of Obstetrics and Gynecology at University of Washington School of Medicine, Seattle, WA, USA
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Preis H, Eisner M, Chen R, Benyamini Y. First-time mothers' birth beliefs, preferences, and actual birth: A longitudinal observational study. Women Birth 2018; 32:e110-e117. [PMID: 29753684 DOI: 10.1016/j.wombi.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 10/16/2022]
Abstract
PROBLEM Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously. BACKGROUND Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare. AIM To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options. METHODS Longitudinal observational study including 342 first-time expectant mothers recruited at women's health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth. FINDINGS Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth. DISCUSSION Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease. CONCLUSION Women's beliefs should be recognized and birth preferences respected.
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Affiliation(s)
- Heidi Preis
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Michal Eisner
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center - Beilinson Hospital, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, 6997801, Israel
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42
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Bond S. Updates From the Literature, May/June 2018. J Midwifery Womens Health 2018; 63:357-361. [DOI: 10.1111/jmwh.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
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43
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Phillippi JC, Danhausen K, Alliman J, Phillippi RD. Neonatal Outcomes in the Birth Center Setting: A Systematic Review. J Midwifery Womens Health 2018; 63:68-89. [DOI: 10.1111/jmwh.12701] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 11/27/2022]
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44
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Mapping midwifery and obstetric units in England. Midwifery 2018; 56:9-16. [DOI: 10.1016/j.midw.2017.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022]
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45
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Jolles DR, Langford R, Stapleton S, Cesario S, Koci A, Alliman J. Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014. Birth 2017; 44:298-305. [PMID: 28850706 PMCID: PMC5873276 DOI: 10.1111/birt.12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Variations in care for pregnant women have been reported to affect pregnancy outcomes. METHODS This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. RESULTS Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery- attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. CONCLUSIONS The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.
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Affiliation(s)
- Diana R. Jolles
- Nurse‐midwife El Rio Community Health CenterFaculty, Frontier Nursing UniversityTucsonAZUSA
| | | | - Susan Stapleton
- American Association of Birth Centers Perinatal Data RegistryPerkiomenvillePAUSA
| | | | - Anne Koci
- Texas Woman's UniversityHoustonTXUSA
| | - Jill Alliman
- American Association of Birth Centers Perinatal Data RegistryPerkiomenvillePAUSA
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46
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Jolles DR. Unwarranted Variation in Utilization of Cesarean Birth Among Low‐Risk Childbearing Women. J Midwifery Womens Health 2017; 62:49-57. [DOI: 10.1111/jmwh.12565] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 05/19/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
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Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review. PLoS One 2016; 11:e0149463. [PMID: 26891444 PMCID: PMC4758623 DOI: 10.1371/journal.pone.0149463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/31/2016] [Indexed: 11/26/2022] Open
Abstract
Background There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications. Methods Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data. Results Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care. Conclusions There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
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