State Scope of Practice Laws, Nurse-Midwifery Workforce, and Childbirth Procedures and Outcomes.

BACKGROUND: Despite research indicating that health, cost, and quality of care outcomes in midwife-led maternity care are comparable with and in some case preferable to those for patients with physician-led care, midwifery plays a more important role in some U.S. states than in others. However, this variability is not well-understood. OBJECTIVES: This study estimates the association between state scope of practice laws related to the autonomy of midwifery practice with the certified nurse-midwifery (CNM) workforce, access to midwife-attended births, and childbirth-related procedures and outcomes. METHODS: Using multivariate regression models, we analyzed Natality Detail File data from births occurring from 2009 to 2011. Each state was classified regarding autonomous midwifery practice (not requiring supervision or contractual agreements) based on Lexis legal search. RESULTS: States with autonomous practice laws had an average of 4.85 CNMs per 1,000 births, compared with 2.17 in states where CNM practice is subject to collaborative agreement. In states with autonomous CNM practice, women had higher odds of having a CNM-attended birth (adjusted odds ratio [AOR], 1.59; p = .004), compared with women in states where midwifery is subject to collaborative agreement. In addition, women in states with autonomous practice had lower odds of cesarean delivery (AOR, 0.87; p = .016), preterm birth (AOR, 0.87; p < .001), and low birth weight (AOR, 0.89; p = .001), compared with women in states without such practice. CONCLUSIONS: States with regulations that support autonomous midwifery practice have a larger nurse-midwifery workforce, and a greater proportion of CNM-attended births. Correlations between autonomous practice laws and better birth outcomes suggest future policy efforts to enhance access to midwifery services may be beneficial to pregnancy outcomes and infant health.

Satisfacción en la provisión de redes de apoyo social en grupos de acompañamiento a la maternidad / Satisfaction in providing social support networks in assistance groups for mothers

Objetivos: Conocer la percepción del grado de satisfacción que tienen las madres, con hijos menores de un año y que participan en las dinámicas grupales que los CAP ofrecen, en relación al contenido y redes de provisión del Apoyo Social (AS) así como las causas que disminuyen la satisfacción en el receptor de este apoyo. Material y métodos: Estudio con diseño cualitativo y enfoque fenomenológico. La población objeto de estudio estaba constituida por madres participantes en dinámicas grupales de cinco CAP de la provincia de Barcelona. Como instrumento de recogida de datos se empleó la entrevista semiestructurada, entre julio de 2011 y julio de 2012; todas fueron grabadas, transcritas y analizadas. Resultados: AS informal: la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional y evaluativo procedente de las enfermeras; identificándose 4 categorías que contribuyen en esta percepción: contacto profesional/accesibilidad, disparidad y/o actualización, confianza y no procede. AS formal, la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional, evaluativo y técnico procedente de la pareja y madre (abuela materna); identificándose 8 categorías en esta percepción: disparidad y/o actualización en los consejos, exigencia, empatía, confianza, inseguridades, tiempo, distancia y no procede. Conclusiones: Los factores identificados deberían considerarse en los planes de mejora de la satisfacción y acompañamiento de las madres en este momento de profundos cambios en su vida; dado que aportar un AS satisfactorio repercute en la promoción de la salud y prevención de la enfermedad (AU)

Objectives: To determine the level of satisfaction of mothers of under one year-old babies who participate in group activities provided by the CAP regarding the content and Social Support (AS), support network as well as the causes that lead to a lower satisfaction level for people receiving this support. Methods: This study includes a qualitative design and phenomenological approach. The study population consisted of mothers participating in group activities in five different CAP in the province of Barcelona. Semi-structured interviews were used as a data collection instrument between July 2011 and July 2012. They were all recorded, transcribed and analyzed. Results: informal AS: most mothers are very or completely satisfied with the information, emotional and evaluative AS from nurses; four categories were identified, that contributed to this perception: professional contact / access, discrepancy and / or update, confidence and not applicable. Formal AS: most mothers are very or completely satisfied with the information, emotional, and technical evaluation from the couple and mother (maternal grandmother) AS; eight categories were identified in this item: discrepancy and / or update on advice, requests, empathy, trust, lack of confidence, time, distance and not appropriate. Conclusions: The factors identified should be considered in plans to improve the satisfaction and support of mothers in this time of profound change in their life since AS provides a satisfactory impact on health promotion and disease prevention (AU)

Legislative engagement at the chapter level: tips for getting involved.

Legislative and advocacy efforts of locally organized groups of nurses can affect local, state and national health care issues. Ways to get involved include participating in AWHONN chapter and section meetings, local health fairs and letter-writing campaigns.

Navigating the maze of newborn screening.

Newborn screening tests are obtained for all live births in the United States in an effort to identify newborns affected with, or at risk for, various genetic and metabolic diseases. This screening began in the early 1960s with an inexpensive screening test for phenylketonuria (PKU), but the introduction of new technology in the 1990s using tandem mass spectrometry provided the means to screen for over 30 additional metabolic disorders. Newborn-screening programs are state funded and operated, and many factors affect whether certain conditions are included in a state's screening program, including how severe the condition would be if left untreated, the prevalence of that condition in the state's population, and whether there is a treatment available that would improve the course of illness. Numerous ethical issues must be considered concerning newborn screening. Some of these are disparity in access to screening and care, cost of screening, lack of standardized protocols for informed consent, and inconsistent policies for not only abnormal laboratory values but also follow-up diagnosis and medical management. Nurses who work with mothers and infants need to (1) be aware of the laws and policies regarding newborn screening for their state, (2) become familiar with the conditions screened, their inheritance patterns, and their early symptoms, and (3) understand what parents need to be told so that they are able to make informed decisions about their newborns.

The role of risk management in maternal-child health.

In today's litigious medical environment, risk managers serve as a support to health care providers by managing potential or actual liability situations. They analyze the facts in an untoward event, help clinicians communicate the appropriate information to the patient and family, and document it in an objective manner. This article briefly describes the inception of the risk managers' role, details how risk managers can provide support to members of the medical and nursing staffs and what their role is in patient safety, and explains various basic legal concepts that are important to understand should litigation ensue following an adverse event.

Caring for pregnant teenagers: medicolegal issues for nurses.

From statutory rape, pregnancy options, mandatory reporting, and emancipation, a wide range of medicolegal issues face teenagers. These issues become even more complex when the teenager is pregnant. Nurses caring for pregnant and parenting teenagers are in a position to offer advocacy and support in family planning, prenatal, obstetric, and pediatrics settings. A comprehensive understanding of common medicolegal issues facing teenagers will help to ensure appropriate patient advocacy.

State regulation, payment policies, and nurse-midwife services.

State regulatory and reimbursement policies continue to exert a strong influence on health workforce policy. Surveys conducted in 1991 and 1995 for the purpose of examining the impact of state regulation on the supply and practice of certified nurse-midwives (CNMs) showed that the single best predictor of the distribution and practice activities of CNMs was the degree to which state policies facilitated or restricted CNM practice.

Consent and informed consent in perinatal and neonatal settings.

It is commonly accepted in American law that an adult of sound mind has the right of self-determination, that is, the right to say what is to be done to his or her own body. This includes the right to accept and refuse treatment for most medical problems or disorders. During the perinatal period, the woman may be asked to submit to procedures and medications for herself and her fetus/ neonate. Nurses must be sure that patients or parents have given valid consent to any type of touching done in the course of nursing care. Furthermore, nurses must be certain that women have given informed consent to the certified nurse-midwife, nurse practitioner, or physician for any treatments or procedures that have inherent risks. The article defines and describes the concepts of consent and informed consent and examines the roles and responsibilities of perinatal nurses in these processes.

Risk management issues in the perinatal setting.

The frequency and severity of obstetric lawsuits make the perinatal area a risk management priority. Risk management deals with the probability that a given risk will result in an adverse outcome and attempts to mitigate the consequences of adverse events. Perinatal care providers cannot escape risk in their everyday work environment. The article explores perinatal risk issues and offers recommendations and risk management strategies that may help minimize perinatal liability in the antepartum, intrapartum, and postpartum areas.

Strategies for change: nursing implementation of the birthing room.

Nurses were primary participants in introducing the birthing room for maternity care in their respective institutions. Based on tape-recorded interviews, this paper is a report on how the idea of a birthing room was initiated, the resistance it encountered, the eight strategies used to implement the idea, and appropriation of the idea by physicians. Although the examples are specific to the development of a birthing room, the strategies can be used by nurses to initiate other changes in perinatal health care delivery. In addition, increased collaboration between nurses and physicians may make some strategies obsolete.