Midwifery Practice and Models of Care

New Largest Ever Waterbirth Study

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Factors affecting third-stage management and postpartum hemorrhage in planned midwife-led home and birth center births in the United States

Abstract Background Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third‐stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery.…

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Abstract BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. METHODS Our multi-stakeholder team…

Temporal Themes in Periviable Birth: A Qualitative Analysis of Patient Experiences

Abstract Objective Periviable birth accounts for a very small percentage of preterm deliveries but a large proportion of perinatal and neonatal morbidity. Understanding parental experiences during and after periviable deliveries may help healthcare providers determine how to best support women during these medically complex, emotionally charged clinical encounters. Methods This…

Asking different questions: A call to action for research to improve the quality of care for every woman, every child

Abstract Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the…

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Abstract Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked…

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Abstract BACKGROUND Women seeking VBAC may find limited in-hospital options. Increasing numbers of US women are delivering by VBAC out-of-hospital. Little is known about neonatal outcomes among those delivering by VBAC in vs. out-of-hospital. OBJECTIVE(S) To compare neonatal outcomes between women delivering via VBAC in hospital vs. out-of-hospital (home and…

Understanding Recent Home-Birth Research

Abstract In the past month, two new studies have been released—one in The New England Journal of Medicine (NEJM; Snowden et al., 2015) and the other in the Canadian Medical Association Journal (Hutton et al., 2015)—comparing out-of-hospital birth outcomes to hospital birth outcomes. These studies join a growing body of…

Making US Out-of Hospital Birth Safer Requires Systems Change

Abstract Birth is as safe as life gets. – Harriette Hartigan, direct-entry midwife What one deems “safe” is inherently subjective, involving a series of judgments and a relative weighing of multiple (and sometimes conflicting) factors. Find full study Subscription only. To request a copy, contact us here Citation Tilden, E.,…

Of Missing Voices and the Obstetric Imaginary

Abstract In this commentary, I respond to an ethical analysis of a case study, reported by Jankowski and Burcher, in which a woman gives birth to an infant with a known heart anomaly of unknown severity, at home, attended by a midwife. Jankowski and Burcher argue that the midwife who…

The Creation of a Consensus Statement by the ACNM, MAMA, and the NACPM: A Modified-Delphi Study on Normal Physiologic Birth

Abstract INTRODUCTION This article describes the process of developing consensus on a definition of, and best practices for, normal physiologic birth in the United States. Evidence supports the use of physiologic birth practices, yet a working definition of this term has been elusive. METHODS We began by convening a task…