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

Introduction: Efforts 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.

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.

Cost-Effectiveness of Continuous Support From a Layperson During a Woman's First Two Births.

Objective: To evaluate the cost-effectiveness and health outcomes related to continuous support from a layperson during a woman's first two births in a theoretical population.

Design: Cost-effectiveness analysis.

Participants: A theoretical cohort of 1.

The Cost-Effectiveness of Professional Doula Care for a Woman's First Two Births: A Decision Analysis Model.

Introduction: Multiple studies have demonstrated the benefits of intrapartum doula care, including lower risk for cesarean birth and shortened labor time for nulliparous women. However, analyses investigating the cost-effectiveness of doula care are limited. This study evaluated the potential cost-effectiveness of professional doula support during a woman's first birth in a theoretical population of US women, with all women having a second birth without doula care.

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.