AWHONN Position Statement on Midwifery Affirms Birthplace Options, Transfer Guidelines

A woman’s right to choose a full range of providers and settings for pregnancy and birth was recently affirmed in a position statement on midwifery by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). In that statement, AWHONN also emphasized the need for smooth, efficient transfer when planned birth center or home births require a transfer to a hospital setting. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital, created by the Collaboration Task Force of the Home Birth Summit, were specifically cited.

In the revised, reaffirmed statement, AWHONN states:

Because women may choose different settings for birth (hospital, free-standing birth center, or home), it is important to develop policies and procedures that will ensure a smooth, efficient transition of the woman from one setting to another if the woman’s clinical presentation requires a different type of care. Exemplary best practice guidelines have been developed for transfer from home or out of hospital birth settings to the hospital (Home Birth Summit, 2014; Maine Center for Disease Control and Prevention, 2014). These guidelines present the core elements for transfer policies in each setting and include actions to promote respectful, interprofessional collaboration; ongoing communication; and compassionate, family-centered care.

To read the full position statement, click here.

Giving Voice To Mothers

Making Social Media Fit Into Your Life As A Birth Professional (1)

Giving Voice to Mothers

What do you think is most important for your birth care?

Researchers from the University of British Columbia invite you to participate in an anonymous survey about experiences with care during pregnancy among families that have not yet been heard. The survey will take about 40-45 minutes to complete, and all of your answers will be kept confidential.  If you need to, you can save your answers and complete the survey in more than one session.

Your participation in this survey is entirely voluntary. You do not have to take part and you can decide to stop the survey at any time without any negative consequences to you. For example, your maternity care will be not be affected by whether you participate in the survey or not.

To begin the survey, click here

Or access the survey at: www.voicesofmothers.org

If you encounter any technical difficulties with the survey, please contact: barbara.karlen@ubc.ca

On behalf of the Research Team: Thank-you for your time.

Saraswathi Vedam (Principal Investigator, University of British Columbia)

Eugene Declercq (Co-Investigator, Boston University)

Are Hospitals the Safest Place for Healthy Women to Give Birth? An Obstetrician Thinks Twice.

New-England-J-M-logo1 June 2015 – Dr. Neel Shah, Assistant Professor of Obstetrics, Gynaecology and Reproductive Biology at Harvard Medical School, published an article earlier this month opening the discussion about treatment intensity in childbirth in the US.

Dr. Shah’s article stems from the United Kingdom’s National Institute for Health and Care Excellence (NICE) new set of guidelines, published in December 2014, which offer evidence-based advice for the care of pregnant women and babies during labour and immediately after birth. This new set of NICE guidelines concluded that healthy women with straightforward pregnancies are safer to give birth at home, or in a midwife-led birth centre, than at a hospital with the care of an obstetrician.

Shortly after publication of the NICE guidelines, The New England Journal of Medicine invited Dr. Neel Shah to write a response to the advice put forward by NICE. Initially, Dr. Shah started his task with plans to form a rebuttal. However soon after delving further into the issue, he realized that such a rebuttal largely came from flaws in the American system, not the British one.

Dr. Shah’s response and discussion focuses around the questions of intensity of care in childbirth – when are medical interventions necessary? And, are hospitals always the best option for giving birth? He introduces his views, as an American obstetrician, while looking at the NICE guidelines and examples from the UK.

Dr. Shah’s full response, A NICE Delivery – The Cross-Atlantic Divide over Treatment Intensity in Childbirth, was published in June 2015 in The New England Journal of Medicine. A companion piece, Are Hospitals the Safest Place For Healthy Women to Give Birth? An Obstetrician Thinks Twice., released alongside the publication in The New England Journal of Medicine can be found in full online at The Conversation.

Further discussion regarding the topic of care intensity in childbirth in the US has also been presented from the New England Journal of Medicine featured as a webinar and forum discussion with NEJM Group Expert Talk. The full webinar hosted by Joe Elia featuring Dr. Neel Shah, Dr. Kirti Patel, and Dr. Toni Golen, can be viewed online.

ACOG/SMFM Propose a New Classification System for US Maternity Care Facilities

ACOG/SMFMJanuary 22, 2015 – American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine issued a consensus document proposing a classification system for levels of maternal care in the US. This document is the second in the ACOG/SMFM Obstetric Care Consensus Series and was designed to reduce maternal mortality.

The document, ACOG/SMFM Obstetric Care Consensus Series – Levels of Maternal Care, introduces a five level classification system based on a facility’s ability to handle various levels of maternal care. Maternal care is defined as referring to all aspects of antepartum, intrapartum, and postpartum care of the pregnant woman. The proposed classification system levels are:

  1. birth centers
  2. basic care (level I)
  3. specialty care (level II)
  4. subspecialty care (level III)
  5. regional perinatal health care centers (level IV)

The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the United States.

The document promotes collaborative care between maternity care professionals including CNMs, CMs, CPMs, and licensed midwives working at birth centers but specifically excludes home birth.

Hormonal Physiology of Childbearing Report released by Childbirth Connection

Hormonal Physiology of Childbearing Report

January 13, 2015 – Childbirth Connection programs at the National Partnership for Women & Families released a major new report, Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care by Sarah J. Buckley. This comprehensive report examines the science on the hormonal physiology of childbearing and its implications for women, babies and maternity care. The report is accompanied by resources for both women and clinicians.

The Lancet Global Health Series on Midwifery Goes Live

June 23, 2014 – The Lancet has published a series comprised of four international studies on midwifery. Developed by a multidisciplinary group of academics, researchers, women and child health advocates, clinicians and policy-makers, the collaborative approach to this series has resulted in the creation of a framework for quality maternal and newborn care.

With women and infants at the center of this framework and midwifery as a key component to its success, the findings of this series support a shift to a whole-system approach that provides quality care for all. In addition to presenting health practitioners and decision-makers with realistic, achievable, sustainable, and evidence-based strategies, the papers address current key issues and challenges affecting the provision of such care.

With the overall goal of positively impacting mothers and babies, it is hoped that the recommendations from this series will be tailored to meet the unique needs of individual communities and countries.

We are thrilled to see that three Home Birth Summit delegates, including Eugene Declercq, Holly Kennedy and Jane Sandall, are key contributors to this important series.

The executive summary can be viewed by clicking here.

Launch of the 2014 State of the World’s Midwifery Report

UNFPA State of the World's Midwifery ReportJune 3, 2014 – The United Nations Population Fund (UNFPA), the International Confederation of Midwives (ICM), the World Health Organization (WHO) and partners have released the 2014 edition of State of the World’s Midwifery: A Universal Pathway – A Woman’s Right to Health. The report presents findings on midwifery from 73 low and middle income countries and a summary of the progress made since the inaugural report in 2011.

Despite the fact that 96 per cent of worldwide maternal mortality, 91 per cent of stillbirths and 93 per cent of infant mortality lies within these 73 countries, they still only have 42 per cent of the world’s physicians, midwives and nurses. According to the report, midwives could reduce maternal and newborn deaths by two thirds and investments in midwifery training at an international level could result in a 1,600 per cent return on investment.

Since the first edition of the report in 2011, 23 of the countries have executed strategies to improve workforce retention in rural and remote areas, and 20 countries have increased enrollment and placement of midwives in underserved regions.

Ensuring that pregnant women have access to at least four antenatal visits and improving access to emergency services when needed have been identified as key areas of focus in the fight to improve maternal and newborn health outcomes in the targeted countries.

The report can be viewed by clicking here.

US MERA 2nd Annual Face-to-Face Workgroup Meeting – Summary Released

ghApril 2014 – The US Midwifery Education, Regulation, and Association (US MERA) Workgroup met on April 10-13, 2014 to continue discussions on how to expand access to high quality midwifery care and physiologic birth for women in all birth settings in the US. The Workgroup includes representatives from AMCB, ACME, ACNM, MANA, MEAC, NACPM and NARM.

During this meeting, US MERA reached an important milestone – agreeing to work together to achieve several important action steps critical to the future of midwifery in the US. In addition, the following key topics were at the center of discussion: barriers to CPM licensing and practice; accreditation of midwifery education processes and programs; and innovative midwifery education models that prepare midwives for entry-level practice while incorporating cost containment.

Click here to read “2014 US MERA Meeting: A Summary Report”

A New Guideline Aimed at Preventing Primary Cesareans

dfMarch 2014 – The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have released the first guideline, Safe Prevention of the Primary Cesarean Delivery, in a new Obstetric Care Consensus series.

The new recommendation was developed with the overall goal of reducing the US national cesarean rate by safely preventing women from having unnecessary cesarean deliveries with their first birth. Some of the key recommendations include:

  • Allowing women with low-risk pregnancies to have a longer first stage of labor.
  • Considering a new definition for the start of the active phase of labor: 6cm cervical dilation, instead of 4cm.
  • Increasing the length of the second stage of labor to two hours for multiparas, three hours for nulliparas and even longer in certain cases, such as the use of an epidural.
  • Avoidance of excessive weight gain in pregnancy.
  • Utilizing tools to assist with vaginal delivery, such as forceps and vacuum.

ACOG and SMFM are encouraging individuals, organizations and governing bodies to conduct research aimed at developing a stronger knowledge base to direct decisions regarding cesarean delivery and to facilitate policy changes that safely lower the rate of primary cesarean births in the US.

The guideline can be viewed on the ACOG website.

US Out-of-Hospital Birth Rate Trends Up

CDC OOH Birth TrendsMarch 2014 – A new data brief issued by the National Center for Health Statistics reveals that the number of births at home and in birth centers in the United States continues to increase. The increase was greatest for non-Hispanic white women and in the Northwest. The risk profile of out of hospital births has also declined significantly over the period, which the report attributes to “appropriate selection of candidates” to give birth at home or birth center. Although the total number of out-of-hospital births is still small at 1.36%, the report predicts that if the upward trend continues it could impact maternity care infrastructure needs and costs. Refer to the CDC web site for a more detailed summary and the full report: Trends in Out-of-Hospital Births in the United States, 1990–2012.

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