Midwifery care during labor and birth in the United States

Combellick, Joan; Telfer, Michelle L.; Ibrahim, Bridget Basile; Novick, Gina; Morelli, Erin M.; James-Conterelli, Sascha; Kennedy, Holly Powell

doi:10.1016/j.ajog.2022.09.044

Cited by 5 publications

(4 citation statements)

References 61 publications

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“…It is possible that midwifery versus obstetrician approaches to labor management may drive the CB differences noted. 7,[9][10][11][12][13][14][15] Labor management concerns about the duration of the second stage center on the balance between patience with labor progress and the avoidance of adverse perinatal outcomes. There is conflicting evidence regarding the association between length of second stage and maternal and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Passive Descent and Epidural Analgesia in Outcomes Associated With Prolonged Pushing Among Nulliparous Individuals in Midwifery Care

Erickson,

Hersh,

Wharton

et al. 2024

J Midwife Womens Health

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IntroductionEfforts to reduce primary cesarean birth may include supporting longer second stages of labor. Although midwifery‐led care is associated with lower cesarean use, little has been published on associated outcomes of prolonged second stage (≥3 hours of pushing) for nulliparous individuals in US hospital‐based midwifery care. Epidural analgesia and the role of passive descent in midwifery‐led care are also underexplored in relation to the second stage. In this study, we report the incidence of prolonged second stage stratified by epidural analgesia and/or passive descent. Secondary aims included calculating the odds of cesarean birth, obstetric anal sphincter injury (OASI), postpartum hemorrhage (PPH), and neonatal complications.MethodsData were collected prospectively from a single academic center in the United States from 2012 through 2019. Our cohort analysis of labors attended by midwives for nulliparous, term, singleton, and vertex pregnancies included both descriptive and inferential statistics comparing outcomes between prolonged versus nonprolonged pushing groups. We stratified the sample and quantified second stage outcomes by epidural analgesia and by use of passive descent.ResultsOf the 1465 births, 17% (n = 247) included prolonged pushing. Cesarean ranged from 2.2% without prolonged pushing to 26.7% with prolonged pushing. Fetal malposition, epidural analgesia, and longer passive descent were more common among those with prolonged active pushing. Despite these factors, neither odds for PPH nor poor neonatal outcomes were associated with prolonged pushing. Those with more than one hour of passive descent in the second stage who also had prolonged active pushing had lower odds for cesarean but higher odds for OASI relative to those who had little passive descent before pushing for more than 3 hours.DiscussionProlonged pushing occurred in nearly 2 of 10 nulliparous labors. Fetal malposition, epidural analgesia, and prolonged pushing were commonly observed with longer passive descent, cesarean, and OASI. Passive descent in these data likely reflects individualized midwifery care strategies when pushing was complicated by fetal malposition or other complexities.

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Section: Introductionmentioning

confidence: 99%

“…On average, second‐stage care management by midwives likely differs from management by obstetricians; however, a search of the literature reveals an evidence gap on this topic. It is possible that midwifery versus obstetrician approaches to labor management may drive the CB differences noted 7,9–15 …”

Section: Introductionmentioning

confidence: 99%

The Role of Passive Descent and Epidural Analgesia in Outcomes Associated With Prolonged Pushing Among Nulliparous Individuals in Midwifery Care

Erickson,

Hersh,

Wharton

et al. 2024

J Midwife Womens Health

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“…Decades of research demonstrate midwives' good outcomes as specialists in physiologic birth, resulting in reduced preterm births, low-birth-weight babies, increased breastfeeding rates, and fewer cesarean births than similar populations cared for by other providers. [11][12][13] In addition to caring for low-risk patients, the majority of midwives care for moderaterisk patients and work alongside physician consultants to care for those who are medically complex and at high risk. 14 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.…”

mentioning

confidence: 99%

“…CNMs/CMs attend only 10.9% of US births,10 which is the reverse of other high-income countries where midwives attend the majority of birth. Decades of research demonstrate midwives’ good outcomes as specialists in physiologic birth, resulting in reduced preterm births, low-birth-weight babies, increased breastfeeding rates, and fewer cesarean births than similar populations cared for by other providers 11–13. In addition to caring for low-risk patients, the majority of midwives care for moderate-risk patients and work alongside physician consultants to care for those who are medically complex and at high risk 14…”

mentioning

confidence: 99%

ACNM’s Commentary on the Midwifery Workforce in the US

Clarke,

Jefferson

2024

Journal of Perinatal &Amp; Neonatal Nursing

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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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