Preventing primary cesarean births: midwifery care.

The incidence of cesarean birth in the United States is alarmingly high and cesareans are associated with added morbidities for women and newborns. Thus strategies to prevent cesarean particularly for low-risk, nulliparous women at term with a singleton fetus are needed. This article addresses evidence-based practices that may be used during intrapartum to avoid primary cesarean, including patience with progress in labor, intermittent auscultation, continuous labor support, upright positions, and free mobility. Second-stage labor practices, such delayed pushing and manual rotation of the fetus, are also reviewed. This package of midwifery-style care practices can potentially lower primary cesarean rates.

Evidence-based practice for intrapartum care: the Pearls of Midwifery.

Care for women in labor in the United States is in a period of significant transition. Many intrapartum care practices that are standard policies in hospitals today were instituted in the 20th century without strong evidence for their effect on the laboring woman, labor progress, or newborn outcomes. Contemporary research has shown that many common practices, such as routine intravenous fluids, electronic fetal monitoring, and routine episiotomies, do more harm than good. In 2010, the American College of Nurse-Midwives released a PowerPoint presentation titled Evidence-Based Practice: Pearls of Midwifery. This presentation reviews 13 intrapartum-care strategies that promote normal physiologic vaginal birth and are associated with a lower cesarean rate. They are also practices long associated with midwifery care. This article reviews the history of intrapartum practices that are now changing, the evidence that supports these changes, and the practical applications for the 13 Pearls of Midwifery.

Selected perinatal outcomes associated with planned home births in the United States.

OBJECTIVE: More women are planning home birth in the United States, although safety remains unclear. We examined outcomes that were associated with planned home compared with hospital births. STUDY DESIGN: We conducted a retrospective cohort study of term singleton live births in 2008 in the United States. Deliveries were categorized by location: hospitals or intended home births. Neonatal outcomes were compared with the use of the χ(2) test and multivariable logistic regression. RESULTS: There were 2,081,753 births that met the study criteria. Of these, 12,039 births (0.58%) were planned home births. More planned home births had 5-minute Apgar score <4 (0.37%) compared with hospital births (0.24%; adjusted odds ratio, 1.87; 95% confidence interval, 1.36-2.58) and neonatal seizure (0.06% vs 0.02%, respectively; adjusted odds ratio, 3.08; 95% confidence interval, 1.44-6.58). Women with planned home birth had fewer interventions, including operative vaginal delivery and labor induction/augmentation. CONCLUSION: Planned home births were associated with increased neonatal complications but fewer obstetric interventions. The trade-off between maternal preferences and neonatal outcomes should be weighed thoughtfully.

Preventing primary cesarean sections: intrapartum care.

Some intrapartum care practices promote vaginal birth, whereas others may increase the risk for cesarean section. Electronic fetal monitoring and use of the Friedman graph to plot and monitor labor progress are associated with increasing the cesarean section rate. Continuous one-to-one support and midwifery management are associated with lower cesarean section rates. This article reviews the evidence that links specific intrapartum care practices to cesarean section. Strategies that can be implemented in the current social and cultural setting of obstetrics today are recommended.

Interprofessional collaborative practice in obstetrics and midwifery.

As the health care system transforms to accommodate an increased need for primary care services and more patients, new models of health care delivery are needed that can provide quality health care services efficiently. An integrated collaborative practice of certified nurse-midwives, obstetrician-gynecologists, and perinatologists is best suited to meet the rapidly changing needs of the maternity health care delivery system. This article reviews the literature on interprofessional collaborative practice and describes the structure, function, and essential elements of successful collaboration in health care.

Can a vaginal birth after cesarean delivery be a normal labor and birth? Lessons from midwifery applied to trial of labor after a previous cesarean delivery.

Women who undergo a trial of labor after a previous cesarean delivery (TOLAC) have special needs prenatally and during the intrapartum period. Counseling about the choice of TOLAC versus an elective repeat cesarean delivery involves complex statistical concepts. Prenatal counseling that is patient centered, individualized, and presented in a way that addresses the health literacy and health numeracy of the recipient encompasses best practices that support patient decision making. Evidence-based practices during labor that support vaginal birth and increase patient satisfaction are of special value for this population.

The use of herbs by california midwives.

OBJECTIVE: To characterize herbal product use (prevalence, types, indications) among Certified Nurse Midwives/Certified Midwives (CNMs/CMs) and Licensed Midwives (LMs) practicing in the state of California and to describe formal education related to herbal products received by midwives during midwifery education. DESIGN/SETTING/PARTICIPANTS: Cross-sectional survey/California/Practicing midwives. METHODS: A list of LMs and CNMs/CMs practicing in California was obtained through the California Medical Board (CMB) and the American College of Nurse Midwives (ACNM), respectively. The survey was mailed to 343 CNMs/CMs (one third of the ACNM mailing list) and 157 LMs (the complete CMB mailing list). RESULTS: Of the 500 surveys mailed, 40 were undeliverable, 146 were returned, and 7 were excluded (30% response rate). Of the 139 completed surveys, 58/102 (57%) of CNMs/CMs and 35/37 (95%) of LMs used herbs, and LMs were more comfortable than CNMs/CMs in recommending herbs to their patients. A majority of LMs had >20 hours of midwifery education on herbs whereas a majority of CNMs/CMs received 0 to 5 hours. Some CNMs/CMs indicated that their practice site limited their ability to use herbs. Common conditions in which LMs and CNMs/CMs used herbs were nausea/vomiting (86% vs. 83%), labor induction (89% vs. 58%), and lactation (86% vs. 65%). Specific herbs for all indications are described. CONCLUSION: Licensed midwives were more likely than CNMs/CMs to use herbs in clinical practice. This trend was likely a reflection of the amount of education devoted to herbs as well as herbal use limitations that may be encountered in institutional facilities.