Defining Midwifery-Led Care in the United States Using Concept Analysis.

National health policy initiatives recommend increased integration of midwifery care in the United States to improve care quality and reduce maternal health disparities. However, the service models through which midwives provide midwifery care and produce quality outcomes are poorly understood. Midwifery-led care is a service model frequently associated with improved outcomes compared with other models.

American Midwifery Certification Board Certification Demographic and Employment Data, 2016 to 2020: The Certified Nurse-Midwife and Certified Midwife Workforce.

Introduction: Expansion and diversification of the midwifery workforce is a federal strategy to address the maternal health crisis in the United States. Understanding characteristics of the current midwifery workforce is essential to creating approaches to its development. Certified nurse-midwives and certified midwives (CNMs/CMs) certified by the American Midwifery Certification Board (AMCB) constitute the largest portion of the US midwifery workforce.

The American College of Nurse-Midwives' Benchmarking Project: A Demonstration of Professional Preservation and Improvement.

Maternal and newborn outcomes in the United States are suboptimal. Care provided by certified nurse-midwives and certified midwives is associated with improved health outcomes for mothers and newborns. Benchmarking is a process of continuous quality assurance providing opportunities for internal and external improvement.

Midwifery students' expectations of and experiences with ethics education: A qualitative study.

Background: Instruction in ethics is an essential component of midwifery education. However, the evidence for how midwifery students experience ethics instruction in the classroom and via clinical experience is limited.

Objective: This study explores midwifery students' perceptions of ethics education and their opinions about essential components of ethics education.

Essential components of midwifery ethics education: results of a Delphi study.

Objective: Ethical dilemmas are an inevitable part of a midwife's experience in clinical care. Midwifery educational programs have an obligation to provide students the opportunities to acquire the skills and knowledge to recognize and negotiate ethical dilemmas. Implementation of strategies for imparting ethical competencies and clinical ethics decision-making skills in formal midwifery curricula have been challenging and inconsistent.

The Impact of Shared Decision-Making in Perinatal Care: A Scoping Review.

Introduction: Shared decision-making is considered to be a key aspect of woman-centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision-making support strategy as the primary intervention in the context of perinatal care.

Methods: A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English-language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision-making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth).

Mediolateral Episiotomy: Technique, Practice, and Training.

Episiotomy is one of the most common obstetric procedures. However, restrictive use of episiotomy has led to a decrease in its use in the United States. Historically, mediolateral episiotomy has been performed less often than median episiotomy in the United States, but both have purported advantages and disadvantages.

"I'm sure we talked about it": Midwives experiences of ethics education and ethical dilemmas, a qualitative study.

Aim: Midwives are expected to identify and help resolve ethics problems that arise in practice, skills that are presumed to be taught in midwifery educational programs. In this study, we explore how midwives recognize ethical dilemmas in clinical practice and examine the sources of their ethics education.

Methods: We conducted semi-structured, individual interviews with midwives from throughout the United States (U.

A retrospective comparison of waterbirth outcomes in two United States hospital settings.

Background: Water immersion during labor is an effective comfort measure; however, outcomes for waterbirth in the hospital setting have not been well documented. Our objective was to report the outcomes from two nurse-midwifery services that provide waterbirth within a tertiary care hospital setting in the United States.

Methods: This study is a retrospective, observational, matched comparison design.

Oxytocin, Vasopressin and Prolactin in New Breastfeeding Mothers: Relationship to Clinical Characteristics and Infant Weight Loss.

Background: Maternal milk production requires the neuropeptide oxytocin. Individual variation in oxytocin function is a compelling target for understanding low milk production, a leading cause of breastfeeding attrition. Complicating the understanding of oxytocin pathways is that vasopressin may interact with oxytocin receptors, yet little is known about the role of vasopressin in lactation.

Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage.

Background: Postpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications.

Breastfeeding Outcomes After Oxytocin Use During Childbirth: An Integrative Review.

Introduction: Despite widespread use of exogenous synthetic oxytocin during the birth process, few studies have examined the effect of this drug on breastfeeding. Based on neuroscience research, endogenous oxytocin may be altered or manipulated by exogenous administration or by blocking normal function of the hormone or receptor. Women commonly cite insufficient milk production as their reason for early supplementation, jeopardizing breastfeeding goals.

Role of Prophylactic Oxytocin in the Third Stage of Labor: Physiologic Versus Pharmacologically Influenced Labor and Birth.

Introduction: Maternity care providers administer oxytocin prophylactically to prevent postpartum hemorrhage (PPH). Prophylactic oxytocin is generally considered effective and safe and is promoted by national organizations for standardized use. In this article, the evidence supporting prophylactic oxytocin administration for women undergoing spontaneous labor and birth compared with women whose labors included administration of exogenous oxytocin for induction or augmentation is explored.

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

Background: Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital.

The Effect of Childbirth Self-Efficacy on Perinatal Outcomes.

Objective: To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes.

Data Sources: Eligible studies were identified through searches of MEDLINE, CINAHL, Scopus, and Google Scholar databases.

Study Selection: Published research articles that used a tool explicitly intended to measure childbirth self-efficacy and that examined outcomes within the perinatal period were included.

The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission.

Introduction: Group prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission.

Methods: A retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs.

The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies.

Objective: The impact of hospital obstetric volume specifically on maternal outcomes remains under studied. We examined the impact of hospital obstetric volume on maternal outcomes in low-risk women who delivered non-low-birthweight infants at term.

Study Design: We conducted a retrospective cohort study of term singleton, non-low-birthweight live births from 2007-2008 in California.

Group prenatal care: review of outcomes and recommendations for model implementation.

The intent and delivery of prenatal care have evolved since its formal inception in the early 1900s. Group prenatal care offers an alternative care delivery model to the currently dominant prenatal care model. The group model has been associated with a number of improved perinatal outcomes including decreased preterm birth, higher birth weight, improved breast-feeding initiation and duration, decreased cesarean delivery, and greater patient satisfaction.

Intermittent auscultation of the fetal heart rate during labor: an opportunity for shared decision making.

Electronic fetal heart rate monitoring is the most common form of intrapartal fetal assessment in the United States. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth.