Are CNM‐Attended Births in Texas Hospitals Underreported?

Biscone, Erin S.; Cranmer, John N.; Lewitt, MaryJane; Martyn, Kristy K.

doi:10.1111/jmwh.12654

Cited by 15 publications

(31 citation statements)

References 12 publications

(12 reference statements)

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“…97 Accurate reporting of those percentages is currently not possible, and CNM-attended hospital births may be underreported when they are not accurately documented on the birth certificate. 98 These issues are confusing for the public and for accurate reporting.…”

Section: Discussionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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Background: The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.

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Section: Discussionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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“…The proportion of midwife-attended births varies widely by state, ranging from 0.6% to 27%, 53 and may be underreported in state vital statistics. 54 State-level health care policy and regulation greatly influence the prevalence and boundaries of midwifery practice. 14 Midwives are an integral part of intrapartum care for many US women, yet the scope and influence of midwifery care in the United States remains limited in many states.…”

Section: Implications For Research and Policymentioning

confidence: 99%

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

Smith

Phillippi

Lowe

et al. 2019

J Midwife Womens Health

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Introduction: The Robson 10-group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification. Methods: We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non-interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities. Results: Women were less likely to have a cesarean birth (26.1% vs 33.5%, P Ͻ .001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%, P Ͻ .001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%, P Ͻ .001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%, P Ͻ .001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12-1.32; P Ͻ .001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups. Discussion: Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.

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“…17,23,24 One underexplored factor is the presence of midwives as part of intrapartum care teams. 28 In health care systems, no one works in isolation; teamwork leads to multiple and interrelated factors shaping care delivery. 26 Although the National Center for Health Statistics collects data on United States births attended by certified nurse-midwives, information on labor interventions and outcomes is limited and at times of uncertain quality.…”

Section: Noninterprofessional Centers (N = 8996) N (%) or Median [5tmentioning

confidence: 99%

“…27 Moreover, there is evidence that underreporting of midwife-managed births on United States birth certificates limits the reliability of state-level, regionlevel, or country-level data. 28 In health care systems, no one works in isolation; teamwork leads to multiple and interrelated factors shaping care delivery. 11 The presence of midwives may drive culture shifts within a hospital or health system.…”

Section: Noninterprofessional Centers (N = 8996) N (%) or Median [5tmentioning

confidence: 99%

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

Carlson

Neal

Tilden

et al. 2018

Birth

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Background: Sixty percent of United States births are to multiparous women. Hospitallevel policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes. K E Y W O R D Scesarean, culture, induced labor, midwifery, multiparous, obstetrics, oxytocin, parturition 488 | CARLSON et AL.

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Are CNM‐Attended Births in Texas Hospitals Underreported?

Abstract: CNMs/CMs need to regularly verify that they are being named as the provider on birth certificates for births they attend and work with advocacy groups, hospital administrators, physicians, legislators, and policy makers to improve the accuracy of birth certificate data.

Cited by 15 publications

References 12 publications

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

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