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LoGiudice JA. Meta-synthesis of the experiences of midwives providing care during the COVID-19 pandemic. Midwifery 2024; 138:104142. [PMID: 39142237 DOI: 10.1016/j.midw.2024.104142] [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: 06/16/2023] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
PROBLEM During the COVID-19 pandemic, midwives faced emotional and physical risks while on the frontlines providing care. BACKGROUND To maintain a healthy midwifery workforce, it is necessary to understand midwives' pandemic challenges and successes, including how they personally and professionally faced changes to care provision. AIM The aim of this meta-synthesis was to understand the experiences of midwives working during the COVID-19 pandemic. METHODS Noblit and Hare's (1988) approach to synthesising qualitative research studies was followed. Fifteen qualitative research reports were identified using PRISMA guidelines, producing a sample of 588 midwives from 12 countries. FINDINGS The synthesis revealed three overarching themes: (1) Turmoil and confusion: a spectrum of emotions due to ever-changing protocols, (2) COVID-19 stripped the "being with" out of midwifery care, and (3) Finding our way: midwifery resilience and growth. Analysed together, these three themes contribute to understanding the experiences of midwives working during the COVID-19 pandemic. DISCUSSION Midwives experienced fear, stress, and anxiety. They felt they couldn't physically be with women during the pandemic. They were frustrated by being left out of institutional decision-making regarding COVID-19 protocols that impacted the women they served. Professional growth as a midwife, and personal resilience were ultimately realised. CONCLUSIONS The COVID-19 pandemic disrupted the routine ways in which midwives provide care in all settings. Understanding the complete experience of midwives during the pandemic allows for midwifery organizations to be aware of their members' needs, as well as for institutions to ensure supports are in place for midwives in the event of future pandemics.
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Affiliation(s)
- Jenna A LoGiudice
- Fairfield University, Egan School of Nursing and Health Studies, 1073 North Benson Rd, Fairfield, CT 06824, USA.
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Thompson-Lastad A, Harrison JM, Taiwo TK, Williams C, Parimi M, Wilborn B, Chao MT. Postpartum care for parent-infant dyads: A community midwifery model. Birth 2024; 51:637-648. [PMID: 38590170 PMCID: PMC11323162 DOI: 10.1111/birt.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. METHODS We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. RESULTS A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. CONCLUSION The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.
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Affiliation(s)
- Ariana Thompson-Lastad
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Jessica M. Harrison
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | | | - Chanda Williams
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
| | - Mounika Parimi
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Briana Wilborn
- Department of Family Health Care Nursing (*alum), School of Nursing, University of California, San Francisco, California, USA
| | - Maria T. Chao
- Osher Center for Integrative Health, University of California, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
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Cellissen E, van Zelm R, Hendrix M, Wildschut HIJ, Nieuwenhuijze M. Integrated maternity care: A concept analysis. PLoS One 2024; 19:e0306979. [PMID: 39088517 PMCID: PMC11293731 DOI: 10.1371/journal.pone.0306979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/26/2024] [Indexed: 08/03/2024] Open
Abstract
INTRODUCTION Integrated maternity care is strongly promoted in the Netherlands. However, the term 'integrated' and its practical meaning is understood differently by professionals and policy makers. This lack of clarity is also visible in other countries and hinders implementation. In this study, we will examine how the concept of 'integrated maternity care' and its defining attributes are presented in the international literature. METHODS This study aims to provide a definition and deeper understanding of the concept of integrated maternity care by conducting a concept analysis using Morse's method. We performed a systematic search using Embase and Ebscohost (CINAHL, PsychINFO, SocINDEX, MEDLINE) including records that described integrated maternity care from on organizational perspective. Through a qualitative analysis of the selected research and non-research records, we identified defining attributes, boundaries, antecedents, and consequences of the concept. Subsequently, we constructed a definition of the concept based on the findings. RESULTS We included 36 records on integrated maternity care in the period from 1978 to 2022. Our search included 21 research and 15 non-research records (e.g. guidelines and policy records). Only half of these had a definition of integrated maternity care. Over time, the definition became more specific. Our concept analysis resulted in three defining attributes of integrated maternity care: collaboration, organizing collaboration and woman-centeredness. We identified role clarity, a culture of collaboration, and clear and timely communication as antecedents of integrated maternity care. A number of consequences were found: continuity of care, improved outcomes, and efficiency. All consequences were described as expected effects of integrated maternity care and not based on evidence. CONCLUSION We propose the following definition: 'Integrated maternity care is woman-centred care provided by (maternity) care professionals collaborating together within and across different levels of healthcare with a specific focus on organizing seamless care.' Addressing the antecedents is important for the successful implementation of integrated maternity care.
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Affiliation(s)
- Evelien Cellissen
- Department of Midwifery Education and Studies, Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
| | - Ruben van Zelm
- University of Applied Sciences, Utrecht, The Netherlands
| | - Marijke Hendrix
- Department of Midwifery Education and Studies, Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
| | | | - Marianne Nieuwenhuijze
- Department of Midwifery Education and Studies, Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Schafer R, Bovbjerg ML, Cheyney M, Phillippi JC. Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study. PLoS One 2024; 19:e0305587. [PMID: 39037977 PMCID: PMC11262641 DOI: 10.1371/journal.pone.0305587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/01/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). DESIGN Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). SETTING Planned community birth (homes and birth centers), United States. SAMPLE Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. METHODS Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. MAIN OUTCOME MEASURES Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. RESULTS One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. CONCLUSIONS All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.
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Affiliation(s)
- Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, NJ, United States of America
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States of America
| | - Marit L. Bovbjerg
- Epidemiology Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, OR, United States of America
| | - Julia C. Phillippi
- School of Nursing, Vanderbilt University, Nashville, TN, United States of America
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Zell B, Effland K, Snyder M, Hays K, Gordon W. Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception. J Midwifery Womens Health 2024; 69:600-605. [PMID: 38229277 DOI: 10.1111/jmwh.13606] [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] [Revised: 10/18/2023] [Indexed: 01/18/2024]
Abstract
Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives' Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
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Affiliation(s)
| | - Kristin Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | | | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | - Wendy Gordon
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
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Manns-James L, Vines S, Alliman J, Hoehn-Velasco L, Stapleton S, Wright J, Jolles D. Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry. Birth 2024; 51:353-362. [PMID: 37929686 DOI: 10.1111/birt.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. METHODS National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. RESULTS Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. CONCLUSIONS Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.
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Affiliation(s)
| | | | - Jill Alliman
- Frontier Nursing University, Versailles, Kentucky, USA
| | | | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Diana Jolles
- Frontier Nursing University, Versailles, Kentucky, USA
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Gabriel JL, Burcher P, Cheyney M. Perceptions and Attitudes Toward Genetic Counselors and Genetic Testing Among Certified Professional Midwives in Vermont: A Modified Grounded Theory Study. QUALITATIVE HEALTH RESEARCH 2024; 34:579-592. [PMID: 38150356 DOI: 10.1177/10497323231222395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Increasingly, pregnant people in the United States are choosing to give at birth at home, and certified professional midwives (CPMs) often attend these births. Care by midwives, including home birth midwives, has the potential to decrease unnecessary medical interventions and their associated health care costs, as well as to improve maternal satisfaction with care. However, lack of integration into the health care system affects the ability of CPMs to access standard medications and testing for their clients, including prenatal screening. Genetics and genomics are now a routine part of prenatal screening, and genetic testing can contribute to identifying candidates for planned home birth. However, research on genetics and midwifery care has not, to date, included the subset of midwives who attend the majority of planned home births, CPMs. The purpose of this study was to examine CPMs' access to, and perspectives on, one aspect of prenatal care, genetic counselors and genetic counseling services. Using semi-structured interviews and a modified grounded theory approach to narrative analysis, we identified three key themes: (1) systems-level issues with accessing information about genetic counseling and genetic testing; (2) practice-level patterns in information delivery and self-awareness about knowledge limitations; and (3) client-level concerns about the value of genetic testing relative to difficulties with access and stress caused by the information. The results of this study can be used to develop decision aids that include information about genetic testing and genetic counseling access for pregnant people intending home births in the United States.
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Affiliation(s)
- Jazmine L Gabriel
- Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, PA, USA
| | - Paul Burcher
- Department of Obstetrics and Gynecology, WellSpan York Hospital, York, PA, USA
- Pennsylvania State University College of Medicine, Hershey, PA, USA
- Drexel University College of Medicine, Philadelphia, PA USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State, Oregon State University, Corvallis, OR, USA
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Anyiam S, Woo J, Spencer B. Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment. J Midwifery Womens Health 2024. [PMID: 38689459 DOI: 10.1111/jmwh.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. METHODS Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. RESULTS The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatal health care. DISCUSSION The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.
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Affiliation(s)
- Shalom Anyiam
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Jennifer Woo
- College of Nursing, Texas Woman's University, Dallas, Texas
| | - Becky Spencer
- College of Nursing, Texas Woman's University, Dallas, Texas
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El Hussein MT, Jacoby S, Mclarnon M, Favell D, Dosani A. A concurrent mixed-method study exploring the experiences of interprofessional collaboration among Canadian midwives and obstetricians. J Adv Nurs 2024. [PMID: 38570936 DOI: 10.1111/jan.16183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/25/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
AIM This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. DESIGN A concurrent mixed-methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. METHOD Eighteen RMs across Canada completed a demographic survey and the Midwifery-Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery-Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi-structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. RESULTS The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife-physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician-midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter-Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. CONCLUSION This study provides support for the Midwifery-Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. IMPLICATIONS The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. REPORTING METHOD The authors adhered to Consolidated criteria for reporting qualitative research (COREQ).
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Affiliation(s)
- Mohamed Toufic El Hussein
- Faculty of Health, Community & Education, Mount Royal University, Calgary, Alberta, Canada
- Clinical Associate, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Jacoby
- Faculty of Health, Community & Education, Mount Royal University, Calgary, Alberta, Canada
| | - Matthew Mclarnon
- Faculty of Health, Community & Education, Mount Royal University, Calgary, Alberta, Canada
| | | | - Aliyah Dosani
- Faculty of Health, Community & Education, Mount Royal University, Calgary, Alberta, Canada
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Clarke H, Jefferson K. ACNM's Commentary on the Midwifery Workforce in the US. J Perinat Neonatal Nurs 2024; 38:113-116. [PMID: 38758262 DOI: 10.1097/jpn.0000000000000830] [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: 05/18/2024]
Abstract
The American College of Nurse-Midwives (ACNM) represents certified nurse-midwives (CNMs) and certified midwives (CMs) who are graduate-prepared advanced practice providers. They attend educational programs accredited by the American Commission for Midwifery Education (ACME) and are certified by the American Midwifery Certification Board (AMCB). Their scope of practice as defined by ACNM includes primary care, reproductive services beginning with menarche through menopause, gender-affirming services, contraception, abortion, prenatal, birth, postpartum, and care of the newborn. CNMs/CMs attend 10.9% of US births, but other high-income countries have the reverse proportion of midwives to obstetricians. The CNM/CM workforce is growing, but retirements and attrition slow the growth. Research demonstrates good outcomes from care provided by midwives, and ACNM's primary goal is to expand the midwifery workforce and increase consumer access to midwifery care to mitigate the persistent rise in maternal mortality and morbidity. Barriers to workforce expansion include restricted practice at the state level, inability to expand the number of seats in education programs due to lack of clinical preceptors, and a lack of diversity in the workforce. Strategies to address these barriers may allow the workforce to grow, increasing access to high-quality, equitable sexual and reproductive care for people in the United States.
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Affiliation(s)
- Heather Clarke
- Author Affiliations: American College of Nurse-Midwives, Washington, District of Columbia
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Thumm EB, Schaeffer A, Michel A, McFarland AK, Long MH, Giano Z. The Relationship Between Restrictive Regulation of Midwives, Practice Environment, and Professional Burnout: A 7-State Mixed-Methods Comparison of Autonomous and Restrictive State Regulation. J Perinat Neonatal Nurs 2024; 38:137-146. [PMID: 38758270 DOI: 10.1097/jpn.0000000000000810] [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: 05/18/2024]
Abstract
PURPOSE The purpose of the study was to investigate the relationship between state regulation of the midwifery workforce, practice environment, and burnout. BACKGROUND Burnout threatens the US midwifery workforce, with over 40% of certified nurse-midwives meeting criteria. Burnout can lead to poorer physical and mental health and withdrawal from the workforce. Burnout in midwives has been associated with lack of control and autonomy. In the United States, midwives' autonomy is restricted through state-level regulation that limits scope of practice and professional independence. METHODS A mixed-methods study was conducted using an explanatory sequential approach. Quantitative and qualitative data were collected by online surveys and analyzed in a 2-stage process, followed by data integration. RESULTS State regulation was not found to be independently associated with burnout (n = 248; P = .250); however, mediation analysis showed a significant association between state regulation, practice environment, and burnout. Qualitative analysis mirrored the importance of practice environment and expanded on its features. CONCLUSION For midwives, unrestrictive practice regulation may not translate to burnout prevention without supportive practice environments. IMPLICATIONS FOR PRACTICE AND RESEARCH Interventions should focus on promoting job flexibility, realistic demands, and professional values. While midwives' commitment to patients and the profession can help bolster the workforce, it can also amplify negative experiences of the practice environment.
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Affiliation(s)
- E Brie Thumm
- Author Affiliations: University of Colorado College of Nursing, Aurora (Dr Thumm); Frontier Nursing University, Versailles, Kentucky (Dr Schaeffer); Rosalind Franklin University College of Nursing, North Chicago, Illinois (Dr Michel); Oregon Health & Science University School of Nursing, Ashland, Oregon (Dr McFarland); Charlottesville, Virginia (Dr Long); and Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora (Dr Giano)
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Cerceo E, Saxer K, Grossman L, Shapley-Quinn K, Feldman-Winter L. The Climate Crisis and Breastfeeding: Opportunities for Resilience. J Hum Lact 2024; 40:33-50. [PMID: 38158719 DOI: 10.1177/08903344231216726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.
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Affiliation(s)
- Elizabeth Cerceo
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Lauren Grossman
- General Internal Medicine and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Lori Feldman-Winter
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ, USA
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Herndon A, Vanderlaan J. Associations Between State Practice Regulations and Access to Midwifery Care. J Midwifery Womens Health 2024; 69:17-24. [PMID: 37354043 DOI: 10.1111/jmwh.13528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/07/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION This study aimed to identify associations between state policies and access to midwifery care. Identifying policies that facilitate increased access to midwives will help policymakers determine the best methods for increasing access to midwives in their states. METHODS This cross-sectional study was conducted at the county level as a secondary analysis of National Vital Statistics data from the Natality online database. The unit of analysis was counties with populations of at least 100,000, and the outcome was the proportion of births attended by midwives in 2019. The potential predictors of increased access to midwifery care were independent midwife licensure, independent midwife prescribing, midwife access to hospital medical staff membership, and midwife Medicaid parity. Medicaid provider resources and state statutes verified Medicaid reimbursement rates and eligibility for hospital medical staff privileges. Each state was categorized as an independent or restricted licensure state according to data from the American College of Nurse-Midwives. Data for the control variable, the presence of a midwifery education program, were gathered from the Accreditation Commission for Midwifery Education. The analysis was conducted as a Poisson regression. RESULTS There was no association between independent licensing and increased access among all states. Stratifying the analysis by independent licensing law revealed that all but one policy was related to higher rates of midwife attendance at birth. Maximum Medicaid reimbursement correlated with greater access regardless of licensing status. The rate of midwife-attended births in independent licensing states grew as the number of potential predictors in a county increased. DISCUSSION Regulatory policies beyond independent licensing are associated with women's access to midwifery services. In independent licensing states, adopting additional policies favorable to midwives may strengthen access to midwifery. Policymakers and regulators can use these findings to identify strategies for accelerating the expansion of midwifery access in their states.
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Affiliation(s)
- Acacia Herndon
- Las Vegas School of Nursing, University of Nevada, Las Vegas, Nevada
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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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15
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Ibrahim BB, Cheyney M, Vedam S, Kennedy HP. "I was able to take it back": Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100339. [PMID: 38239391 PMCID: PMC10795544 DOI: 10.1016/j.ssmqr.2023.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.
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Affiliation(s)
- Bridget Basile Ibrahim
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, United States
| | - Melissa Cheyney
- Oregon State University, Waldo Hall 224, 2250 SW Jefferson Way, Corvallis, OR, 97331, United States
| | - Saraswathi Vedam
- University of British Columbia, Birth Place Lab, UBC Midwifery, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Holly Powell Kennedy
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, United States
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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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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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18
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McGlothen-Bell K, Greene MZ, Hunt G, Crawford AD. Intersectional Examination of Gender-Inclusive Care and Women's Health. J Obstet Gynecol Neonatal Nurs 2023; 52:442-453. [PMID: 37699533 PMCID: PMC11217877 DOI: 10.1016/j.jogn.2023.08.007] [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: 03/20/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
Transgender and gender-nonconforming people remain excluded from women's health spaces, and nurses with expertise in women's health best serve their needs when they seek sexual, reproductive, gynecologic, or obstetric care. However, commentary regarding the term "women" and exclusionary policies and behaviors in health care marginalize gender-nonconforming patients and contribute to health disparities. Therefore, the purpose of this article is twofold. First, we review terminology related to gender-nonconforming populations and their known health care needs; provide a brief historical overview of gender and health care; and describe the influence of White supremacist, misogynist, and heteronormative influences in women's health care. Second, we generate a call to action and specifically discuss the responsibilities of nurses and nursing organizations to ensure the provision of gender-equitable and respectful care and generate clinical recommendations for the specialty.
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Bazirete O, Hughes K, Lopes SC, Turkmani S, Abdullah AS, Ayaz T, Clow SE, Epuitai J, Halim A, Khawaja Z, Mbalinda SN, Minnie K, Nabirye RC, Naveed R, Nawagi F, Rahman F, Rasheed SI, Rehman H, Nove A, Forrester M, Mandke S, Pairman S, Homer CSE. Midwife-led birthing centres in four countries: a case study. BMC Health Serv Res 2023; 23:1105. [PMID: 37848936 PMCID: PMC10583445 DOI: 10.1186/s12913-023-10125-2] [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: 06/01/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. METHODS A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. RESULTS Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. CONCLUSION The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.
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Affiliation(s)
- Oliva Bazirete
- College of Medicine and Health, Sciences, University of Rwanda, Kigali, Rwanda.
- Novametrics Ltd, Duffield, UK.
| | | | | | | | - Abu Sayeed Abdullah
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | | | - Abdul Halim
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | - Karin Minnie
- University of the Western Cape, Cape Town, South Africa
| | | | - Razia Naveed
- Research & Development Solutions, Islamabad, Pakistan
| | | | - Fazlur Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | - Hania Rehman
- Research & Development Solutions, Islamabad, Pakistan
| | | | - Mandy Forrester
- International Confederation of Midwives, The Hague, Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, Netherlands
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Jewett CG, Sobiech KL, Donahue MC, Alexandrova M, Bucher S. Providing Emotional Support and Physical Comfort During a Time of Social Distancing: A Thematic Analysis of Doulas' Experiences During the Coronavirus Pandemic. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:89-98. [PMID: 37724030 DOI: 10.1177/0272684x221094172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Doulas are trained, non-clinical professionals that provide a continuum of support for mothers. An interpretive phenomenological approach was used to explore the professional experiences of doulas (n = 17) during the COVID-19 pandemic in the US. Data were collected using brief intake surveys, in-depth semi-structured interviews, and an online discussion group. After a list of significant statements was created and grouped during emergent themes analysis, the reflections were summarized into three themes, (1) Doula Resilience, (2) Experiencing Vulnerability, and (3) Concern for Client Vulnerability that encapsulate the experiences of doulas during the COVID-19 pandemic. We conclude that as part of the COVID-19 recovery process, policy makers should look to non-clinical interventions for improving maternal health, such as promoting and supporting synergy between doulas and other maternal health service providers.
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Affiliation(s)
- Christian G Jewett
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Kathleen L Sobiech
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Marie C Donahue
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Maria Alexandrova
- Eck Institute for Global Health, University of Notre Dame, South Bend, IN, USA
| | - Sherri Bucher
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Clark E, Solomon J, Cunningham SD, Bard K, Storey AS. Leadership Link: Evaluation of an Online Leadership Curriculum for Certified Midwives and Certified Nurse-Midwives. J Midwifery Womens Health 2023; 68:627-636. [PMID: 37202902 DOI: 10.1111/jmwh.13508] [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: 09/26/2022] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Midwifery leadership is vital for improving maternal health outcomes, yet limited leadership training opportunities exist. This study evaluated acceptability and preliminary outcomes of Leadership Link, a scalable online learning program that aims to increase midwives' leadership competencies. METHODS The program evaluation study enrolled early-career midwives (<10 years since certification) into an online leadership curriculum using the LinkedIn Learning platform. The curriculum consisted of 10 courses (approximately 11 hours) of self-paced, non-health care-specific leadership content supplemented with brief midwifery-specific introductions from midwifery leaders. A preprogram, postprogram, and follow-up study design was used to evaluate changes in 16 self-assessed leadership abilities, self-perception as a leader, and resilience. Data were also collected on the application of leadership skills acquired through, and career advancements attributed to, program participation. RESULTS A total of 186 individuals activated LinkedIn Learning accounts. Almost half (41.9%) completed the full curriculum. Satisfaction was high, with 83.3% of postprogram survey respondents reporting the program was "probably" or "definitely" worth the time invested. Seventy-six participants (40.9%) provided matched pre- and immediate postprogram survey data on at least some of the 16 self-assessed leadership abilities. All 16 abilities showed statistically significant increases in pre- to postprogram mean scores, ranging from 6.4% to 32.5%. Both self-perception as a leader and resilience scores significantly increased from baseline. More than 87% of postprogram and follow-up survey respondents reported having applied new or improved leadership abilities to at least a small degree. Fifty-eight percent of follow-up survey respondents reported at least one midwifery career advancement, of whom 43.6% attributed the advancement, at least in part, to Leadership Link. DISCUSSION The findings suggest that the online Leadership Link curriculum is acceptable and may be effective in improving midwives' leadership capacity, potentially enhancing career opportunities and engagement in system change.
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Affiliation(s)
- Emma Clark
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Julie Solomon
- J. Solomon Consulting, LLC, Mountain View, California
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Kristin Bard
- J. Solomon Consulting, LLC, Mountain View, California
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Vanderlaan J. Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes. J Midwifery Womens Health 2023; 68:588-595. [PMID: 37114625 DOI: 10.1111/jmwh.13500] [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: 11/22/2022] [Revised: 01/25/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Studies comparing pregnancy outcomes before and after state transition to independent midwifery practice have found little change in primary cesarean birth and preterm birth rates. One reason may be the failure to control for midwife density. The objective was to test if the local midwife density moderates the association between state independent midwifery practice and pregnancy outcomes. METHODS Birth records were abstracted from the State Inpatient Databases for 6 states. The Area Health Resource File provided county variables. Midwife density was operationalized as no midwives, low midwife density (<4.5 per 1000 births), and high midwife density (≥4.5 midwives per 1000 births). Multivariate logistic regression models compared primary cesarean birth and preterm birth, controlling for maternal and county characteristics. Moderation was tested by including an interaction term (independent practice × density) to the regression models. The magnitude of association for the interaction was measured by stratifying the models. RESULTS The study included 875,156 women; most (79.7%) resided in a county with low midwife density. Restricted midwifery practice was associated with increased odds of both primary cesarean birth and preterm birth. The interaction term was significant for both preterm birth and primary cesarean, indicating moderation. The largest magnitude of difference was the increased odds of preterm birth in counties with a high midwife density and restricted practice (odds ratio, 3.50; 95% CI, 2.43-5.06) compared with those with high midwife density and independent practice. DISCUSSION Midwife density moderates the association between independent midwifery practice and primary cesarean birth and preterm birth. Moderation may explain why prior studies found small or no changes in outcomes when states adopted independent practice. Moderation models can improve testing for associations with independent practice. Both midwife independent practice and increasing midwifery workforce size can be strategies to improve state pregnancy outcomes.
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Affiliation(s)
- Jennifer Vanderlaan
- School of Nursing, University of Nevada Las Vegas, Las Vegas, Nevada, United States
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23
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Maimburg RD, Declercq ER, de Jonge A. Midwifery care is evidence-based but under increasing pressure. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100858. [PMID: 37209445 DOI: 10.1016/j.srhc.2023.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Baumont MS, Dekker CS, Rabinovitch Blecker N, Turlington Burns C, Strauss NE. Every Mother Counts: listening to mothers to transform maternity care. Am J Obstet Gynecol 2023; 228:S954-S964. [PMID: 37164500 DOI: 10.1016/j.ajog.2022.12.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 05/12/2023]
Abstract
More than a decade ago, the United Nations Human Rights Council passed a resolution recognizing maternal health as a human right. Subsequently, global advocates mobilized to establish the right to respectful maternity care, which has since been formally recognized by the World Health Organization and endorsed by more than 90 international, civil society, and health professional organizations. Despite widespread acknowledgment of this right, traditional approaches to maternity care do not adequately address aspects of quality care that are highly valued by mothers and birthing people, such as respect, dignity, and shared decision-making, and high numbers of women and birthing people worldwide continue to experience disrespect and mistreatment during childbirth. Efforts to reduce maternal mortality have historically overemphasized clinical approaches while failing to listen to mothers and pregnant people, threatening patient autonomy, and contributing to persistent racial disparities and high levels of preventable maternal mortality. This article shares the birth story and evolution of Every Mother Counts, an organization dedicated to making pregnancy and childbirth safe, respectful, and equitable for every mother, everywhere, and provides tangible examples of how storytelling and listening to women-in film, media, research, advocacy, education, and patient care-can serve as powerful vehicles to create awareness of maternal health issues and transform our maternity care system into one that centers mothers in labor and childbirth and elevates equity and birth justice. There are concrete steps that every participant in the maternity care system can take to help make respectful, equitable care a reality, including implementing patient-reported experience measures as part of standard clinical practice, using individualized care plans and shared decision-making tools in patient care, and developing a grievance process to address instances of disrespectful care and mistreatment. Most importantly, we can listen to mothers, women, and birthing people, hear their concerns, and act promptly to provide the care and support that they deserve.
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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: 8] [Impact Index Per Article: 8.0] [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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Combellick JL, Telfer ML, Ibrahim BB, Novick G, Morelli EM, James-Conterelli S, Kennedy HP. Midwifery care during labor and birth in the United States. Am J Obstet Gynecol 2023; 228:S983-S993. [PMID: 37164503 DOI: 10.1016/j.ajog.2022.09.044] [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: 07/21/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/12/2023]
Abstract
The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.
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Affiliation(s)
| | | | | | - Gina Novick
- Yale University School of Nursing, Orange, CT
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O'Connell MA, Sosa G. Midwifery in Abu Dhabi: A descriptive survey of midwives. Women Birth 2023:S1871-5192(23)00034-3. [PMID: 36822961 DOI: 10.1016/j.wombi.2023.02.002] [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: 08/31/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Midwives of international standards may save lives on a scale unmatched by any other intervention. There are limited trained midwives in Abu Dhabi. Midwifery may be eroded or diminished if there is attrition and/ or no succession of trained midwives (Bharj et al., 2016). Therefore, high quality midwifery education is needed. AIM This study aimed to describe midwifery in Abu Dhabi to inform the development of a new midwifery education degree program. METHODS In 2022, midwives working in Abu Dhabi were invited to an anonymous online questionnaire. Data collected included characteristics such as age, qualification, duration of practice, practice setting, and skills used. Excel was used to perform descriptive statistics. FINDINGS Seventeen midwives participated (N = 17). The majority (58.8%, n = 10) work in Labour Ward, four midwives rotated to antenatal, labour, and postnatal areas (23.5%, n = 4). Midwives came from many countries, but there were no midwives of Emirati nationality. Seventy per cent held Undergraduate (70.5%, n = 12) and almost a third held Postgraduate (29.5%, n = 5) midwifery degrees. Skills commonly used included parentcraft (47.0%, n = 8), promoting physiologic labour and birth encouraging freedom of movement (93.8%, n = 15), facilitating safe spontaneous vaginal births (88.2%, n = 15), perineal and vaginal suturing (68.8%, n = 11) and immediate care of the newborn (100.0%, n = 17). Midwives less commonly led antenatal assessments (37.5%, n = 6) and worked in postnatal areas (31.3%, n = 4). CONCLUSION Understanding midwives' characteristics, where they work, and skills used may inform Midwifery education. Having more midwives will strengthen midwifery and increase women's choice for respectful, safe maternity care.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Nursing and Midwifery, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.
| | - Georgina Sosa
- School of Nursing and Midwifery, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
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We Do Not Know How People Have Babies: an Opportunity for Epidemiologists to Have Meaningful Impact on Population-Level Health and Wellbeing. CURR EPIDEMIOL REP 2023. [DOI: 10.1007/s40471-023-00321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Mehra R, Alspaugh A, Joseph J, Golden B, Lanshaw N, McLemore MR, Franck LS. Racism is a motivator and a barrier for people of color aspiring to become midwives in the United States. Health Serv Res 2023; 58:40-50. [PMID: 35841130 PMCID: PMC9836944 DOI: 10.1111/1475-6773.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To understand motivators and barriers of aspiring midwives of color. DATA SOURCES AND STUDY SETTING Primary data were collected via a national online survey among people of color in the United States interested in pursuing midwifery education and careers between February 22 and May 2, 2021. STUDY DESIGN Cross-sectional survey consisted of 76 questions (75 closed-ended and 1 open-ended questions) including personal, familial, community, and societal motivators and barriers to pursuing midwifery. DATA COLLECTION/EXTRACTION METHODS We recruited respondents 18 years and older who identified as persons of color by posting the survey link on midwifery, childbirth, and reproductive justice listservs, social media platforms, and through emails to relevant midwifery and doula networks. We conducted descriptive and bivariate analyses by demographic characteristics and used exemplar quotes from the open-ended question to illustrate findings from the descriptive data. PRINCIPAL FINDINGS The strongest motivating factors for the 799 respondents were providing racially concordant care for community members (87.7 percent), reducing racial disparities in health (67.2 percent), and personal experiences related to midwifery care (55.4 percent) and health care more broadly (54.6 percent). Main barriers to entering midwifery were direct (58.2 percent) and related (27.5 to 52.8 percent) costs of midwifery education, and lack of racial concordance in midwifery education and the midwifery profession (31.5 percent) that may contribute to racially motivated exclusion of people of color. Financial and educational barriers were strongest among those with lower levels of income or education. CONCLUSIONS Structural and interpersonal racisms are both motivators and barriers for aspiring midwives of color. Expanding and diversifying the perinatal workforce by addressing the financial and educational barriers of aspiring midwives of color, such as providing funding and culturally-competent midwifery education, creating a robust pipeline, and opening more midwifery schools, is a matter of urgency to address the maternal health crisis.
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Affiliation(s)
- Renee Mehra
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Amy Alspaugh
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA,College of NursingUniversity of TennesseeKnoxvilleTennesseeUSA
| | | | - Bethany Golden
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Nikki Lanshaw
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Monica R. McLemore
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
| | - Linda S. Franck
- Department of Family Health Care NursingSchool of Nursing, University of CaliforniaSan FranciscoCaliforniaUSA
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Li T, Zeng Y, Fan X, Yang J, Yang C, Xiong Q, Liu P. A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science. J Multidiscip Healthc 2023; 16:677-692. [PMID: 36938484 PMCID: PMC10015947 DOI: 10.2147/jmdh.s398218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/17/2023] [Indexed: 03/13/2023] Open
Abstract
Objective This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science. Methods Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords. Results Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05). Conclusion This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.
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Affiliation(s)
- Tingting Li
- Department of Science and Education, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Yilan Zeng
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xianrong Fan
- Department of Hospital Office, The Maternal and Child Health Hospital of Yongchuan, Chongqing, People’s Republic of China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Chengying Yang
- Department of Obstetrics and Gynecology, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Qingyun Xiong
- Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, Changsha, Hunan Province, People’s Republic of China
- Qingyun Xiong, Department of Ultrasonography, Changsha Hospital of Traditional Chinese Medicine, No. 22, Xingsha Avenue, Changsha County, Changsha City, Hunan Province, 410100, People’s Republic of China, Tel +86 731-85259000, Email
| | - Ping Liu
- Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, Changsha, Hunan Province, People’s Republic of China
- Correspondence: Ping Liu, Department of Respiratory and Critical Care Medicine, Changsha Hospital Affiliated to Xiangya Medical College, Central South University, 311 Yingpan Road, Kaifu District, Changsha, Hunan Province, 410005, People’s Republic of China, Tel +86 15973136512, Email
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Basile Ibrahim B, Kozhimannil KB. Racial Disparities in Respectful Maternity Care During Pregnancy and Birth After Cesarean in Rural United States. J Obstet Gynecol Neonatal Nurs 2023; 52:36-49. [PMID: 36400125 PMCID: PMC9839498 DOI: 10.1016/j.jogn.2022.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the experiences of pregnancy and birth after cesarean of women who live in rural areas of the United States, including access to vaginal birth after cesarean (VBAC), type of maternity care provider, travel times, autonomy in decision making, and respectful maternity care. DESIGN Retrospective observational study. SETTING Online questionnaire of women who gave birth in the United States. PARTICIPANTS Women (N = 1,711) with histories of cesarean and subsequent births within 5 years of participating. METHODS We calculated descriptive and bivariate statistics by identified areas of residence and stratified measures of autonomy and respectful maternity care by self-identification as a member of a racialized group. We applied qualitative descriptive analysis to responses to an open-ended survey question. RESULTS A total of 299 (17.5%) participants identified their areas of residence as rural. Similar percentages of rural and metropolitan participants were able to plan VBAC (p = .88). More rural participants than metropolitan participants reported travel times of more than 60 minutes to give birth (p < .001), and fewer had obstetricians (p = .002) or doulas (p = .03). Rural participants from racialized groups experienced significantly less respectful maternity care than White, non-Hispanic rural participants and all metropolitan participants (p = .04). Qualitative data illustrating the main findings are included. CONCLUSIONS Our findings highlight challenges faced by rural residents accessing VBAC and help explain why rates of VBAC in rural areas remain low. We suggest a range of clinical and policy strategies to improve access to VBAC in rural areas and to improve the quality of maternity care for racialized women who live in rural areas.
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Boakye PN, Prendergast N, Bandari B, Anane Brown E, Odutayo AA, Salami S. Obstetric racism and perceived quality of maternity care in Canada: Voices of Black women. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199651. [PMID: 37772754 PMCID: PMC10542226 DOI: 10.1177/17455057231199651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Obstetric racism in healthcare encounters impact on access to quality maternal healthcare for Black childbearing women yet remains underexplored in Canada. Understanding the experiences of Black Canadian women is critical to inform policy and create targeted interventions to address obstetric racism and advanced maternal health equity. OBJECTIVE The aim of this study was to explore the experiences of obstetric racism and its influence on perceived quality of maternity care among Black women in Toronto, Canada. DESIGN Qualitative research was conducted using a critical qualitative inquiry approach. METHODS We conducted a semi-structured interviews with 24 Black women who were pregnant and/or have given birth in the last 3 years. The interviews explored their experiences seeking care during pregnancy/childbirth and perceived quality of care. RESULTS Two themes were generated through the process of thematic analysis: (1) Manifestations and Impacts of Obstetric Racism and (2) Strategies for Addressing Obstetric Racism. Narratives of being dismissed, objectified, dehumanized, trauma and paternalism were reflected in the accounts of the participants. These experiences undermined the quality of care, hindered therapeutic relationships and contributed to mistrust. CONCLUSION Black women understood the nature and impact of obstetric racism as it relates to the quality of maternal health care, their safety, and well-being. Participants recommended the need for anti-Black racism training specific to caring of Black childbearing women and increasing Black healthcare provider representation in perinatal settings as strategies to address obstetric racism. Investment in Black maternal health research is urgently needed to generate meaningful evidence to inform policy and interventions to advanced maternal health equity.
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Affiliation(s)
| | | | | | | | | | - Sharon Salami
- Toronto Metropolitan University, Toronto, ON, Canada
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Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
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Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Grayson N, Quinones N, Oseguera T. A Model of True CHOICES: Learnings from a Comprehensive Sexual and Reproductive Health Clinic in Tennessee that Provides Abortions and Opened the City's First Birth Center. J Midwifery Womens Health 2022; 67:689-695. [PMID: 36471539 DOI: 10.1111/jmwh.13448] [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: 03/02/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
CHOICES Memphis Center for Reproductive Health staff is passionate about ensuring that everyone has access to the full continuum of comprehensive reproductive health care (including abortion, gender-affirming care, miscarriage management, and community birth) regardless of race, gender identity, sexual orientation, HIV status, economic status, or religious beliefs. Memphis, Tennessee, has a history of limited community birth options (birthing outside of hospital walls). In 2017, when home birth services were added to CHOICES and plans for opening Memphis' first freestanding birth center were being imagined, it was intentional to create a model in which midwifery care could be accessible for patients who may be eligible for state-funded health care services, those considered at higher health risk than traditional low-risk midwifery patients, or both. In fact, individuals and their families with limited out-of-pocket funds and those historically marginalized would purposely receive holistic, individualized care based on their unique health care needs and personal desires, driven by a reproductive justice framework. In this article, we outline the success and challenges of addressing the reproductive health needs of marginalized communities, including the benefits of a nonprofit business model, operationalizing reproductive justice concepts, and the reclamation of Black midwifery. We also discuss the challenges of caring for Black birthing people and providing abortion and gender-affirming care in a politically hostile environment. Although individuals have complex needs, at its core, CHOICES believes that every person must be seen as whole human beings and that each can be cared for by a midwife. The CHOICES approach is informed by evidence-based information, clinical judgment, and an intentional partnership with and investment in a people who have historically been and are presently pushed to the margins, neglected, and blamed for poor health outcomes and demise. Striving to adapt the CHOICES model of care in other parts of the country is important now more than ever following the Supreme Court decision to overturn Roe v. Wade.
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Affiliation(s)
- Nikia Grayson
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Nicole Quinones
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
| | - Talita Oseguera
- CHOICES: Center for Reproductive Health, Memphis, Tennessee, United States
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Hays K, Denmark M, Levine A, de Regt RH, Andersen HF, Weiss K. Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care. J Midwifery Womens Health 2022; 67:701-706. [PMID: 36433815 PMCID: PMC10099526 DOI: 10.1111/jmwh.13441] [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: 03/12/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/27/2022]
Abstract
In Washington state, planned community births are attended by direct entry licensed midwives (LMs) and certified nurse-midwives (CNMs). The most recently published vital statistics data from 2018 reported that 3.6% of the 84,648 births in Washington occurred at home or in freestanding birthing centers. Approximately 16.2% of planned home birth and birth center clients experience intrapartum or early postpartum transfer to the hospital, while 1.8% of their newborns do. The safety of and satisfaction with these types of referrals depends on multisystem processes performed by a variety of health care professionals. Smooth Transitions is a quality improvement (QI) initiative in Washington state that was developed to enhance interprofessional collaboration between community-based midwives, emergency medical services (EMS), and hospital personnel to improve the quality of hospital transfers from planned community settings. Key interventions to date have included (1) information sharing to dispel misconceptions and provide context regarding community births and midwives; (2) co-creation of transfer guidelines; (3) regularly held interprofessional meetings to review transfers and build relationships; and (4) ongoing review of qualitative feedback that captures the perspectives of all involved. Responses on questionnaires and audits indicate that Smooth Transitions has had a positive impact on provider, staff, and patient experiences with hospital transfers. Future endeavors will include strengthening quantitative data collection processes to measure safety indicators, expanding relationships with EMS, and building a case review process that is legally protected. By engaging representatives of all stakeholder groups and addressing community-to-hospital transfers as a multisystems issue, replication of the Smooth Transitions QI Program nationally could promote increased community midwifery integration by enhancing the referral experience for both patients and caregivers.
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Affiliation(s)
- Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington.,Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington
| | - Melissa Denmark
- Department of Midwifery, Bastyr University, Kenmore, Washington.,Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington
| | - Audrey Levine
- Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington
| | | | - H Frank Andersen
- Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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I Am Advocating for the Future. J Perinat Neonatal Nurs 2022; 36:380-381. [PMID: 36288449 DOI: 10.1097/jpn.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
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Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
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Woeber K, Vanderlaan J, Long MH, Steinbach S, Dunn JL, Bouchard ME. Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic. J Midwifery Womens Health 2022; 67:608-617. [PMID: 36098518 DOI: 10.1111/jmwh.13400] [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: 08/10/2021] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic. METHODS An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making. RESULTS Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P < .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P < .001), and salary (19.7% vs 7.0%; P < .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes. DISCUSSION Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.
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Affiliation(s)
- Kate Woeber
- Frontier Nursing University, Versailles, Kentucky
| | | | | | | | - Jessica L Dunn
- Tennessee Technological University, Cookeville, Tennessee
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Meighan KA, Bovbjerg ML, Benyshek DC, Cheyney MJ, Crittenden AN. Prevalence and Predictors of Postpartum Cosleeping Practices after Midwife-Led Births in the US. J Pediatr 2022; 248:46-50.e1. [PMID: 35660492 DOI: 10.1016/j.jpeds.2022.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate patterns of mother-infant sleeping behaviors among US-based mothers who received care from midwives and breastfed their infants the majority of time at 6 weeks postpartum. STUDY DESIGN Infant sleep locations were reported for 24 915 mother-infant dyads followed through 6 weeks postpartum, following midwife-led singleton births. Using data derived from medical records, we used multinomial logistic regression to identify predictors of sleep location. RESULTS The median maternal age was 31 years (IQR, 27-34 years). The majority were White (84.5%), reported having a partner or spouse (95%), had a community birth (87%), and reported bedsharing with their infant for part (13.2%) or most of the night (43.8%). In the adjusted analysis, positive predictors of always bedsharing included increasing maternal age (OR, 1.17; 95% CI, 1.13-1.21; per 5 years), cesarean birth (OR, 1.49; 95% CI, 1.18-1.86), Medicaid eligibility (OR, 1.76; 95% CI, 1.62-1.91), and maternal race/ethnicity (Black OR, 1.40 [95% CI, 1.09-1.79]; Latinx OR, 1.53 [95% CI, 1.35-1.74]; multiracial OR, 1.69 [95% CI, 1.39-2.07]). Negative predictors of bedsharing included having a partner/spouse (OR, 0.66; 95% CI, 0.56-0.77) and birth location in hospitals (OR, 0.56; 95% CI, 0.49-0.64) or birthing centers (OR, 0.48; 95% CI, 0.44-0.51). Partial breastfeeding dyads were less likely to bedshare than those who were exclusively breastfeeding (always bedsharing OR, 0.48 [95% CI, 0.41-0.56]; sometimes bedsharing OR 0.69 [95% CI, 0.56-0.83]). CONCLUSIONS These data suggest that cosleeping is common among US families who choose community births, most of whom exclusively breastfeed through at least 6 weeks.
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Affiliation(s)
| | - Marit L Bovbjerg
- Epidemiology Program, College of Public Health & Human Sciences, Oregon State University, Portland, OR
| | | | - Melissa J Cheyney
- Department of Anthropology, School of Language, Culture, and Society, Oregon State University, Portland, OR
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MacDorman MF, Barnard-Mayers R, Declercq E. United States community births increased by 20% from 2019 to 2020. Birth 2022; 49:559-568. [PMID: 35218065 DOI: 10.1111/birt.12627] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anecdotal and emerging evidence suggested that the 2020 COVID-19 pandemic may have influenced women's attitudes toward community birth. Our purpose was to examine trends in community births from 2019 to 2020, and the risk profile of these births. METHODS Recently released 2020 birth certificate data were compared with prior years' data to analyze trends in community births by socio-demographic and medical characteristics. RESULTS In 2020, there were 71 870 community births in the United States, including 45 646 home births and 21 884 birth center births. Community births increased by 19.5% from 2019 to 2020. Planned home births increased by 23.3%, while birth center births increased by 13.2%. Increases occurred in every US state, and for all racial and ethnic groups, particularly non-Hispanic Black mothers (29.7%), although not all increases were statistically significant. In 2020, 1 of every 50 births in the United States was a community birth (2.0%). Women with planned home and birth center births were less likely than women with hospital births to have several characteristics associated with poor pregnancy outcomes, including teen births, smoking during pregnancy, obesity, and preterm, low birthweight, and multiple births. More than two-thirds of planned home births were self-paid, compared with one-third of birth center and just 3% of hospital births. CONCLUSIONS It is to the great credit of United States midwives working in home and birth center settings that they were able to substantially expand their services during a worldwide pandemic without compromising standards in triaging women to optimal settings for safe birth.
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Affiliation(s)
- Marian F MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
| | | | - Eugene Declercq
- Boston University School of Public Health, Boston, Massachusetts, USA
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George EK, Shorten A, Lyons KS, Edmonds JK. Factors influencing birth setting decision making in the United States: An integrative review. Birth 2022; 49:403-419. [PMID: 35441421 DOI: 10.1111/birt.12640] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United States has the highest perinatal morbidity and mortality (M&M) rates among all high-resource countries in the world. Birth settings (birth center, home, or hospital) influence clinical outcomes, experience of care, and health care costs. Increasing use of low-intervention birth settings can reduce perinatal M&M. This integrative review evaluated factors influencing birth setting decision making among women and birthing people in the United States. METHODS A search strategy was implemented within the CINAHL, PubMed, PsycInfo, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the review, and the Johns Hopkins Nursing Evidence-Based Practice model was used to evaluate methodological quality and appraisal of the evidence. The Whittemore and Knafl integrative review framework informed the extraction and analysis of the data and generation of findings. RESULTS We identified 23 articles that met inclusion criteria. Four analytical themes were generated that described factors that influence birth setting decision making in the United States: "Birth Setting Safety vs. Risk," "Influence of Media, Family, and Friends on Birth Setting Awareness," "Presence or Absence of Choice and Control," and "Access to Options." DISCUSSION Supporting women and birthing people to make informed decisions by providing information about birth setting options and variations in models of care by birth setting is a critical patient-centered strategy to ensure equitable access to low-intervention birth settings. Policies that expand affordable health insurance to cover midwifery care in all birth settings are needed to enable people to make informed choices about birth location that align with their values, individual pregnancy characteristics, and preferences.
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Affiliation(s)
- Erin K George
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Allison Shorten
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Joyce K Edmonds
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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Akerson S, Taiwo TK, Denmark MA, Collins-Fulea C, Emeis C, Davis R, Pilliod RA. Quality Improvement in Community Birth: A Call to Action. J Midwifery Womens Health 2022; 67:544-547. [PMID: 35993827 DOI: 10.1111/jmwh.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Cathy Emeis
- Frontier Nursing University, Versailles, Kentucky, Silver Spring, Maryland, USA.,California Association of Licensed Midwives, San Leandro, California, USA
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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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Adeyemo OO, Morelli EE, Kennedy HP. How to Foster Effective Midwife-Obstetrician Collaboration on Labor and Birth Units: Qualitative Analysis of Experiences of Clinicians in the United States. J Midwifery Womens Health 2022; 67:552-560. [PMID: 35754313 DOI: 10.1111/jmwh.13382] [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: 11/23/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Effective collaboration between midwives and obstetricians on labor and birth units in hospitals has been shown to improve birth outcomes and quality of care. Guidelines for collaborative care in the United States exist; however, studies describing the actual lived experiences of midwives and obstetricians in collaborative practice are lacking. The goal of this study was to explore the experiences and perspectives of midwives and obstetricians working in collaborative practices on labor and birth units across the United States and to identify strategies that foster effective collaboration between them. METHODS We performed qualitative analyses of open-ended comments obtained in an instrument validation survey assessing collaboration between midwives and obstetricians on labor and birth in the United States. Certified nurse-midwives, certified midwives, attending general obstetricians, maternal-fetal medicine attending physicians, and fellows across the United States were included in this study, herein called midwives and obstetricians. The final sample in the original validation survey included 232 midwives and 471 obstetricians (n = 703). Of these, 79 midwives and 132 obstetricians (n = 211) provided narrative comments on their perspectives and experiences with collaborative practice on labor and birth units in the United States. The narrative comments were analyzed using inductive techniques derived from grounded theory. RESULTS Four themes around how to foster effective collaboration were identified: (1) developing trust and respect, (2) promoting effective communication, (3) individual variability and need for clear guidelines, and (4) balancing autonomy. The midwives and obstetricians shared lived experiences that they perceived affected their work satisfaction and clinical outcomes in collaborative practices. DISCUSSION These findings hold potential to inform clinicians and health care leaders on ways to foster effective collaboration between midwives and obstetricians on labor and birth units. This in turn can improve quality of care for birthing persons, perinatal outcomes and clinician job satisfaction.
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Affiliation(s)
- Oluwatosin O Adeyemo
- Division of Obstetric Specialties and Midwifery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States
| | - Erin E Morelli
- Yale School of Nursing, Orange, Connecticut, United States
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Thumm EB, Stimpfel AW, Squires A. Dimensions of being a Midwife and Midwifery Practice in the United States: A Qualitative Analysis. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundMidwives are a vital component of addressing maternal mortality crisis in the United States (US); however, there is scant understanding of the elements of midwifery practice that affect patient outcomes and the stability of the midwifery workforce in the country. This study investigates US midwives’ perceptions of factors influencing their practice and willingness to stay in the profession.MethodsWe applied a pragmatic qualitative design using summative content analysis techniques to code 1,035 comments from a national sample of 2,887 certified nurse-midwives and certified midwives. Two coders identified categories and themes of midwives’ perceptions of their practice environments, which were confirmed by an independent auditor.ResultsEight themes emerged from the data: I love midwifery but…; feeling valued and respected…or not; workload; time and its consequences; the multilevel geography of midwifery practice; changes at odds with quality midwifery care; midwives withdrawing from practice to cope; and the ambiguity of “I just want to practice like a midwife”.ConclusionMidwives readily identified aspects of their practice environment that negatively impact quality of care and stability of the midwifery workforce, including not valuing midwives, high workload, regulatory restrictions, and moral distress; however, respondents expressed strong commitment to the profession of midwifery. The findings also demonstrated the lack of a universally accepted definition of midwifery care within respondents’ professional communities and among respondents. Initiatives to increase integration of midwifery into the U.S. perinatal health system will benefit from taking these findings into consideration.
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Curtin M, Carroll L, Szanfranska M, O’Brien D. Embedding continuity of care into a midwifery curriculum in the Republic of Ireland: A historical context. Eur J Midwifery 2022; 6:20. [PMID: 35515092 PMCID: PMC8998086 DOI: 10.18332/ejm/146232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/29/2022] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary Curtin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lorraine Carroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marcelina Szanfranska
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Denise O’Brien
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Jolles DR, Montgomery TM, Blankstein Breman R, George E, Craddock J, Sanders S, Niemcyzk N, Stapleton S, Bauer K, Wright J. Place of Birth Preferences and Relationship to Maternal and Newborn Outcomes Within the American Association of Birth Centers Perinatal Data Registry, 2007-2020. J Perinat Neonatal Nurs 2022; 36:150-160. [PMID: 35476769 DOI: 10.1097/jpn.0000000000000647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to describe sociodemographic variations in client preference for birthplace and relationships to perinatal health outcomes. METHODS Descriptive data analysis (raw number, percentages, and means) showed that preference for birthplace varied across racial and ethnic categories as well as sociodemographic categories including educational status, body mass index, payer status, marital status, and gravidity. A subsample of medically low-risk childbearing people, qualified for birth center admission in labor, was analyzed to assess variations in maternal and newborn outcomes by site of first admission in labor. RESULTS While overall clinical outcomes exceeded national benchmarks across all places of admission in the sample, disparities were noted including higher cesarean birth rates among Black and Hispanic people. This variation was larger within the population of people who preferred to be admitted to the hospital in labor in the absence of medical indication. CONCLUSION This study supports that the birth center model provides safe delivery care across the intersections of US sociodemographics. Findings from this study highlight the importance of increased access and choice in place of birth for improving health equity, including decreasing cesarean birth and increasing breastfeeding initiation.
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Affiliation(s)
- Diana R Jolles
- Frontier University, Tucson, Arizona (Dr Jolles); American Association of Birth Centers Research Committee, Perkiomenville, Pennsylvania (Drs Jolles, Niemcyzk, and Stapleton and Mss Sanders, Bauer, and Wright); Department of Nursing, Temple University College of Public Health, Philadelphia, Pennsylvania (Dr Montgomery); University of Maryland School of Nursing, Baltimore (Dr Blankstein Breman); Boston College Connell School of Nursing, Boston, Massachusetts (Ms George); University of Maryland College of Social Work, Baltimore (Dr Craddock); and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Sanders and Dr Niemcyzk)
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Curtis RS, Vadney R, Heckert C, Román C. Contrasting Birth Preferences to Practices in El Paso, Texas. Front Glob Womens Health 2022; 3:830512. [PMID: 35425936 PMCID: PMC9002094 DOI: 10.3389/fgwh.2022.830512] [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: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Despite calls for increased access to midwifery and a reduction in unnecessary labor interventions by the World Health Organization, the American College of Obstetrics and Gynecologists, and the American Public Health Association, for many birthing parents in the United States, this model remains out of reach. Only 10% of U.S. births are attended by midwives, and in Texas, which leads the nation in maternal morbidity and mortality, that number is <7%. This study examines an unmet demand for personalized, low-intervention midwifery care in El Paso, Texas and the surrounding area through surveys and focus groups aimed at exploring women's perceptions of their birthing experiences and access to different models of perinatal care. Resulting data suggests a high level of satisfaction with midwifery among those who were able to access it, while those who had used obstetric care often reported limited options and feelings of trauma.
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Affiliation(s)
| | | | - Carina Heckert
- Department of Sociology and Anthropology, The University of Texas at El Paso, El Paso, TX, United States
| | - Cathy Román
- Department of Sociology and Anthropology, The University of Texas at El Paso, El Paso, TX, United States
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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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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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