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Yao X, Shan S, Li Y, Ding L, Wan Y, Zhao Y, Huang R. Roles and challenges encountered by midwives in the management of postpartum haemorrhage following normal vaginal delivery: A scoping review. Nurs Open 2024; 11:e2221. [PMID: 38923309 PMCID: PMC11194447 DOI: 10.1002/nop2.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery. DESIGN We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations. METHODS We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations. RESULTS We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.
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Affiliation(s)
- Xiao Yao
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
| | - Shan‐Shan Shan
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
| | - Yue‐Hong Li
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
| | - Li‐Jing Ding
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
| | - Yue Wan
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
| | - Yin‐Yi Zhao
- School of Nursing and Health ManagementShanghai University of Medicine & Health SciencesShanghaiChina
| | - Rong Huang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghai200092China
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Daly D, Sedlicka N, Švanderlíková K, Kovařčíková PA, Wilhelmová R, Begley C. An online survey of women's views of respectful and disrespectful pregnancy and early labour care in the Czech Republic. BMC Pregnancy Childbirth 2024; 24:370. [PMID: 38750412 PMCID: PMC11097455 DOI: 10.1186/s12884-024-06448-5] [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: 01/06/2023] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, DO2 T283, Ireland.
| | - Natalie Sedlicka
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - Kateřina Švanderlíková
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - PetraAnn Ann Kovařčíková
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - Radka Wilhelmová
- Faculty of Medicine, Department of Health Sciences, Masaryk University, Brno, Czech Republic
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, DO2 T283, Ireland
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Golden BN, Elrefaay S, McLemore MR, Alspaugh A, Baltzell K, Franck LS. Midwives' experience of telehealth and remote care: a systematic mixed methods review. BMJ Open 2024; 14:e082060. [PMID: 38553065 PMCID: PMC10982796 DOI: 10.1136/bmjopen-2023-082060] [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: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Increasing the midwifery workforce has been identified as an evidence-based approach to decrease maternal mortality and reproductive health disparities worldwide. Concurrently, the profession of midwifery, as with all healthcare professions, has undergone a significant shift in practice with acceleration of telehealth use to expand access. We conducted a systematic literature review to identify and synthesize the existing evidence regarding how midwives experience, perceive and accept providing sexual and reproductive healthcare services at a distance with telehealth. METHODS Five databases were searched, PubMed, CINHAL, PsychInfo, Embase and the Web of Science, using search terms related to 'midwives', 'telehealth' and 'experience'. Peer-reviewed studies with quantitative, qualitative or mixed methods designs published in English were retrieved and screened. Studies meeting the inclusion criteria were subjected to full-text data extraction and appraisal of quality. Using a convergent approach, the findings were synthesized into major themes and subthemes. RESULTS After applying the inclusion/exclusion criteria, 10 articles on midwives' experience of telehealth were reviewed. The major themes that emerged were summarized as integrating telehealth into clinical practice; balancing increased connectivity; challenges with building relationships via telehealth; centring some patients while distancing others; and experiences of telehealth by age and professional experience. CONCLUSIONS Most current studies suggest that midwives' experience of telehealth is deeply intertwined with midwives' experience of the response to COVID-19 pandemic in general. More research is needed to understand how sustained use of telehealth or newer hybrid models of telehealth and in-person care are perceived by midwives.
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Affiliation(s)
- Bethany N Golden
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Shaimaa Elrefaay
- Department of Community Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Monica R McLemore
- Child, Family, and Population Health Nursing Department, University of Washington, Seattle, Washington, USA
| | - Amy Alspaugh
- The University of Tennessee Knoxville College of Nursing, Knoxville, Tennessee, USA
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Breman RB, Waddell A, Watkins V. Shared Decision Making in Perinatal Care. J Obstet Gynecol Neonatal Nurs 2024; 53:96-100. [PMID: 38403272 DOI: 10.1016/j.jogn.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
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McLean KA, Souter VL, Nethery E. Expanding midwifery care in the United States: Implications for clinical outcomes and cost. Birth 2023; 50:935-945. [PMID: 37449767 DOI: 10.1111/birt.12748] [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: 05/12/2022] [Revised: 07/22/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND This study compared clinical and financial outcomes for low-risk birthing people between those attended by midwives and those attended by obstetricians during hospital births. METHODS We conducted a retrospective cohort analysis of births from January 1, 2016 to December 31, 2020 at hospitals participating in a perinatal quality improvement collaborative, Obstetrical Care Outcomes Assessment Program (OB COAP), in the Northwest region of the United States and estimated risk ratios using a multivariate regression approach with a modified Poisson binomial for mode of delivery, labor interventions, and newborn outcomes comparing midwife-led to obstetrician-led care. Using publicly available data on average costs of vaginal and cesarean births, we then extrapolated the cost differences in care between midwives and obstetricians. RESULTS Births in the midwife group were less likely to be associated with induction (17.6% vs. 20.3% RR 0.74; 95% CI 0.70-0.78), epidural use (58.9% vs. 76.3% RR 0.78; 95% CI 0.77-0.80), and episiotomy (2.2% vs. 3.4% RR 0.68; 95% CI 0.58-0.81). Cesarean birth was also lower in the midwifery group (7.8% vs. 12.3% RR 0.68, 95% CI 0.62-0.73), without a corresponding increase in risk in adverse neonatal outcomes. We estimated that expanding midwifery care to 100% of low-risk births across the United States could save as much as $340 million per year. CONCLUSIONS Midwifery care is associated with a lower risk of cesarean birth and other interventions versus care provided by obstetricians and is therefore likely lower-cost.
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Affiliation(s)
| | | | - Elizabeth Nethery
- The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Nagineviciute M, Bartuseviciene E, Blazeviciene A. Woman-Centered Care: Standardized Outcomes Measure. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1537. [PMID: 37763656 PMCID: PMC10533153 DOI: 10.3390/medicina59091537] [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: 07/27/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Patient- or woman-centered care, prioritizing women's perspectives, needs, and preferences, is a widely recommended approach to enhance the quality of maternity care services. It aligns with the broader principles of patient-centered care, emphasizing the importance of a collaborative and respectful relationship between healthcare providers and women. This study evaluates low-risk pregnancies managed by midwives and obstetrician-gynecologists in Lithuania using patient-reported outcome measures and patient-reported experience measures. Materials and Methods: A prospective cohort study was conducted between September 2022 and April 2023. Data were collected through patient-reported questionnaires. Results: A total of 153 pregnant women who had singleton, low-risk pregnancies participated in the study, of whom 24.8% had their pregnancies supervised by a midwife, and 75.2% of the participants had their pregnancies supervised by an obstetrician-gynecologist. The study found no statistically significant differences in assessed patient-reported outcome measures and patient-reported experience measures between both models of care. Conclusions: Adopting patient-centered approaches enables healthcare systems to understand and address women's specific needs and preferences, fostering high-quality and woman-centered care. This research adds to the growing evidence supporting midwife-led care and emphasizes the importance of personalized, woman-centered approaches in maternity care, ultimately enhancing maternal health outcomes and promoting positive experiences for low-risk pregnant women. The quality of care provided by midwives remains uncompromised and equivalently proficient compared to the care provided by collaborative teams.
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Affiliation(s)
- Milda Nagineviciute
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Bartuseviciene
- Department of Obstetrics and Gynecology, Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Aurelija Blazeviciene
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
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Basile Ibrahim B, Interrante JD, Fritz AH, Tuttle MS, Kozhimannil KB. Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1077. [PMID: 35884061 PMCID: PMC9324486 DOI: 10.3390/children9071077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample's (n = 93) median SVI score [IQR] was 0.55 [0.25-0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88-0.98] compared with 0.38 [0.19-0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13-0.97), midwifery care (aOR 0.35, 95% CI 0.12-0.99), doula support (aOR 0.30, 95% CI 0.11-0.84), postpartum support groups (aOR 0.25, 95% CI 0.09-0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01-0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.
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Affiliation(s)
- Bridget Basile Ibrahim
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
- School of Nursing, Yale University, Orange, CT 06477, USA
| | - Julia D. Interrante
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Alyssa H. Fritz
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Mariana S. Tuttle
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
| | - Katy Backes Kozhimannil
- University of Minnesota Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55414, USA; (J.D.I.); (A.H.F.); (M.S.T.); (K.B.K.)
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“Mix of Races, Bad Uterus”: Obstetric Violence in the Experiences of Afro-Brazilian Migrants in Portugal. SOCIETIES 2022. [DOI: 10.3390/soc12030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this article, I address the issues of obstetric violence and racism in the Portuguese setting of obstetric care. Based on data collected through interviews and participatory artistic creation, I analyze the perception of three Afro-Brazilian migrants about their perinatal experiences of obstetric care in the Portuguese public sector between 2013 and 2019. These women’s experiences have much in common with experiences of obstetric violence as narrated by Portuguese, non-racialized women. Despite this, certain aspects of their experience are related to their particular identification as Brazilian, migrant, and Black, such as xenophobic discrimination and their placement in systems of stratified reproduction, including a supposed tendency for birth by caesarean section, as well as self-policing behaviors because of the stereotype of Brazilian women as flirty. I consider a range of manifestations of obstetric violence and racism, from more overt forms to more covert ones, to analyze how, in a country where racism and obstetric violence are only slowly beginning to be recognized as the norm, multiple discriminations intersect and have an impact on the experiences of women of their bodies in pregnancy, birth, and postpartum, including breastfeeding.
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Tesfalul MA, Feuer SK, Castillo E, Coleman-Phox K, O'Leary A, Kuppermann M. Patient and provider perspectives on preterm birth risk assessment and communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2814-2823. [PMID: 33892976 PMCID: PMC9005337 DOI: 10.1016/j.pec.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To describe and compare how obstetric patients and care providers view preterm birth risk assessment and communication. METHODS We conducted eight focus groups with obstetric patients (n = 35) and 16 qualitative interviews with obstetric providers. Grounded theory was used to identify and analyze themes. RESULTS Patients' knowledge about preterm birth varied greatly. Similar benefits and risks of preterm birth risk counseling were discussed by patients and providers with notable exceptions: patients cited preparedness as a benefit and providers cited maternal blame, patient alienation, and estimate uncertainty as potential risks. Most patients expressed a desire to know their personalized preterm birth risk during pregnancy. Providers differed in whether they offer universal versus selective, and quantitative versus qualitative, preterm birth risk counseling. Many providers expressed concern about discussing social and structural risk factors for preterm birth. CONCLUSION While many patients desired knowing their personalized preterm birth risk, prenatal care providers' disclosure practices vary because of uncertainty of estimates, concerns about negative consequences and challenges of addressing systemic inequities and social determinants of health. PRACTICE IMPLICATIONS Given the existing asymmetry of information about preterm birth risk, providers should consider patient preferences regarding and potential benefits and risks of such disclosure in their practice.
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Affiliation(s)
- Martha A Tesfalul
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
| | - Sky K Feuer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Esperanza Castillo
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Allison O'Leary
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
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Poškienė I, Vanagas G, Kirkilytė A, Nadišauskienė RJ. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis. Open Med (Wars) 2021; 16:1537-1543. [PMID: 34722889 PMCID: PMC8520123 DOI: 10.1515/med-2021-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth. OBJECTIVE The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes. PARTICIPANTS Pregnant women in Kaunas city maternity care facilities. METHODS A propensity score-matched case-control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann-Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups. RESULTS After adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure. CONCLUSION The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.
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Affiliation(s)
- Ingrida Poškienė
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu st. 2, Kaunas, Lithuania
| | | | - Asta Kirkilytė
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu st. 2, Kaunas, Lithuania
| | - Rūta Jolanta Nadišauskienė
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical Academy, Eiveniu st. 2, Kaunas, Lithuania
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Breman RB, Phillippi JC, Tilden E, Paul J, Barr E, Carlson N. Challenges in the Triage Care of Low-Risk Laboring Patients: A Comparison of 2 Models of Practice. J Perinat Neonatal Nurs 2021; 35:123-131. [PMID: 33900241 PMCID: PMC9083212 DOI: 10.1097/jpn.0000000000000552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.
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Affiliation(s)
- Rachel Blankstein Breman
- University of Maryland School of Nursing, Baltimore (Dr Breman and Mr Barr); Vanderbilt School of Nursing, Nashville, Tennessee (Dr Phillippi); School of Nursing and School of Medicine, Oregon Health and Science University, Portland (Dr Tilden); Perinatal Behavioral Health Clinic, Weymouth, Massachusetts (Dr Paul); and Emory University School of Nursing, Atlanta, Georgia (Dr Carlson)
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Hamlin L, Grunwald L, Sturdivant RX, Koehlmoos TP. Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System. Policy Polit Nurs Pract 2021; 22:105-113. [PMID: 33615908 DOI: 10.1177/1527154421994071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America's largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012-2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women's health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.
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Affiliation(s)
- Lynette Hamlin
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Lindsay Grunwald
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | | | - Tracey P Koehlmoos
- Health Services Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
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Abstract
OBJECTIVE To compare midwife and obstetrician labor practices and birth outcomes in women with low-risk pregnancies delivered in the hospital. METHODS We conducted a retrospective cohort study of singleton births of 37 0/7-42 6/7 weeks of gestation at 11 hospitals between January 1, 2014, and December 31, 2018. Exclusions included intrapartum transfer from home-birth center, antepartum stillbirth, previous cesarean delivery, practitioner other than midwife or obstetrician, prelabor cesarean, prepregnancy maternal disease, and pregnancy complications or risk factors. Interventions (induction, artificial rupture of membranes, epidural, oxytocin, and episiotomy), mode of delivery, maternal outcomes (third- or fourth-degree laceration, postpartum hemorrhage, blood transfusion, and severe maternal morbidity), and newborn outcomes (shoulder dystocia, 5-minute Apgar score less than 7, resuscitation at delivery, birth trauma, and neonatal intensive care unit admission) were examined by practitioner type. We used modified Poisson regression models adjusted for individual confounders to assess risk ratios, stratified by parity, for health care provider type and perinatal outcomes. RESULTS The study cohort comprised 23,100 births (3,816 midwife and 19,284 obstetrician). Compared with obstetricians, midwifery patients had significantly lower intervention rates, an approximately 30% lower risk of cesarean delivery in nulliparous patients (adjusted relative risk [aRR] 0.68; 95th% CI 0.57-0.82), and an approximately 40% lower risk of cesarean in multiparous patients (aRR 0.57; 95th% CI 0.36-0.89). Operative vaginal birth was also less common in nulliparous patients (aRR 0.73; 95th% CI 0.57-0.93) and multiparous patients (aRR 0.30; 95th% CI 0.14-0.63). Shoulder dystocia was more common in multiparous patients receiving midwifery care (aRR 1.42; 95th% CI 1.04-1.92). CONCLUSIONS In low-risk pregnancies, midwifery care in labor was associated with decreased intervention, decreased cesarean and operative vaginal births, and, in multiparous women, an increased risk for shoulder dystocia. Greater integration of midwifery care into maternity services in the United States may reduce intervention in labor and potentially even cesarean delivery, in low-risk pregnancies. Larger research studies are needed to evaluate uncommon but important maternal and newborn outcomes.
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Welffens K, Derisbourg S, Costa E, Englert Y, Pintiaux A, Warnimont M, Kirkpatrick C, Buekens P, Daelemans C. The "Cocoon," first alongside midwifery-led unit within a Belgian hospital: Comparison of the maternal and neonatal outcomes with the standard obstetric unit over 2 years. Birth 2020; 47:115-122. [PMID: 31746028 PMCID: PMC7065252 DOI: 10.1111/birt.12466] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim was to compare maternal and neonatal outcomes of women with a low-risk pregnancy attending the "Cocoon," an alongside midwifery-led birth center and care pathway, with women with a low-risk pregnancy attending the traditional care pathway in a tertiary care hospital in Belgium. METHODS We performed a retrospective cohort study of maternal and neonatal outcomes of women with a low-risk pregnancy who chose to adhere to the Cocoon pathway of care (n = 590) and women with a low-risk pregnancy who chose the traditional pathway of care (n = 394) from March 1, 2014, to February 29, 2016. We performed all analyses using an intention-to-treat approach. RESULTS In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25-0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30-0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09-0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17-0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively. CONCLUSIONS Women planning their births in the midwifery-led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery-led care pathways in other hospitals in Belgium.
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Affiliation(s)
- Karine Welffens
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Sara Derisbourg
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Elena Costa
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Yvon Englert
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Axelle Pintiaux
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Michèle Warnimont
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Christine Kirkpatrick
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Pierre Buekens
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane UniversityNew Orleans, Louisiana
| | - Caroline Daelemans
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
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Declercq ER, Belanoff C, Sakala C. Intrapartum Care and Experiences of Women with Midwives Versus Obstetricians in the Listening to Mothers in California Survey. J Midwifery Womens Health 2019; 65:45-55. [PMID: 31448884 PMCID: PMC7028014 DOI: 10.1111/jmwh.13027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Abstract
Introduction Many studies based on hospital records or vital statistics have found that childbearing women experience benefits of lower rates of intervention with midwifery care versus obstetric care during labor and birth. Surveys of women's views and experiences can provide a richer analysis when comparing intrapartum care of midwives and obstetricians.
Methods This study was a secondary analysis of data from the population‐based Listening to Mothers in California survey. The sample, which was representative of 2016 California hospital births, was drawn from birth certificate files and oversampled midwife‐attended births. Women responded to the survey in English or Spanish on any device or with a telephone interviewer. The present analysis is based on 1421 of the 2539 participants who identified a midwife or obstetrician as their attendant at a vaginal birth. A bivariate analysis of demographic, attitudinal, and intrapartum variables was conducted. A multivariable model included sociodemographic and attitudinal variables as covariates. Results Bivariate analyses found significant socioeconomic differences by type of intrapartum care provider, with women in California attended by midwives more likely to be well educated and privately insured than women attended by obstetricians. Women with midwife birth attendants were less likely to report experiencing various intrapartum medical interventions, less likely to experience pressure to have epidural analgesia, and more likely to report that staff encouraged the woman's decision making. Adjusted odds ratios found that women with midwives were less likely to experience medical interventions, including attempted labor induction; labor augmentation; and use of pain medications, epidural analgesia, and intravenous fluids; and less likely to report pressure to have labor induction or epidural analgesia. Women cared for by midwives were more likely to experience any nonpharmacologic pain relief measures and nitrous oxide and to agree that hospital staff encouraged their decision making. Discussion Using women's own reports of their care experiences and adjusting for possible differences in women's attitudes and case mix, we found that midwifery care of women who had vaginal births was associated with reduced use of medical interventions and increased women's decisional latitude during labor and birth.
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Affiliation(s)
- Eugene R Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Carol Sakala
- National Partnership for Women & Families, Washington, District of Columbia
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