Catherine A. Carr

Use of a Maternity Support Binder for Relief of Pregnancy‐Related Back Pain

Objective: To examine the feasibility, acceptability, and effectiveness of a support binder for low back pain in pregnancy. Design: Pilot study, using a prospective, two-group design with repeated measures. Setting: Ambulatory maternity clinic in a tertiary care teaching hospital. Participants: Women of at least 20 weeks gestation with low back pain, but no preexisting back or disc disease. Thirty women assigned to the intervention group and 10 to a comparison group. Interventions: Participants completed a pain assessment at pretest. Intervention participants received a maternity support binder to wear while awake for 2 weeks. At an appointment 2 weeks later, a posttest questionnaire and a taped interview were administered. The comparison group participants received the support binder after the second appointment. Main Outcome Measures: Back pain intensity, duration, and effect on daily activities were assessed using a pain in pregnancy questionnaire. Results: The intervention group had significant reduction in mean pain scores and effect of pain on daily activities, including family, house and yard, recreational, exercise, and sleep. Interaction of group by time was significant for change in pain and effect on family, house and yard, and exercise activities. Conclusion: The use of a support binder for pregnancy-related low back pain is a promising intervention and was well-accepted by the participants.OBJECTIVE To examine the feasibility, acceptability, and effectiveness of a support binder for low back pain in pregnancy. DESIGN Pilot study, using a prospective, two-group design with repeated measures. SETTING Ambulatory maternity clinic in a tertiary care teaching hospital. PARTICIPANTS Women of at least 20 weeks gestation with low back pain, but no preexisting back or disc disease. Thirty women assigned to the intervention group and 10 to a comparison group. INTERVENTIONS Participants completed a pain assessment at pretest. Intervention participants received a maternity support binder to wear while awake for 2 weeks. At an appointment 2 weeks later, a posttest questionnaire and a taped interview were administered. The comparison group participants received the support binder after the second appointment. MAIN OUTCOME MEASURES Back pain intensity, duration, and effect on daily activities were assessed using a pain in pregnancy questionnaire. RESULTS The intervention group had significant reduction in mean pain scores and effect of pain on daily activities, including family, house and yard, recreational, exercise, and sleep. Interaction of group by time was significant for change in pain and effect on family, house and yard, and exercise activities. CONCLUSION The use of a support binder for pregnancy-related low back pain is a promising intervention and was well-accepted by the participants.

Vaginal birth after cesarean section: a pilot study of outcomes in women receiving midwifery care

A recent trend discouraging or not offering women a choice to labor after a cesarean birth has resulted in higher cesarean birth rates and lower rates of vaginal birth after cesarean birth (VBAC). The few studies describing midwifery practice have demonstrated favorable outcomes; however, the studies are too small to thoroughly evaluate critical outcomes. In this retrospective descriptive study, clinical outcome data were obtained from eight midwifery practices. The aims were to collect, aggregate, and analyze data from multiple midwifery practices and then describe outcomes. Usable data representing 649 trials of labor were submitted. Overall, 72% (range 64%-100%) of women gave birth vaginally. Mean infant birth weight was 3,501 (SD = 534) g, and the mean Apgar scores were 7.99 (SD = 1.4; median 8) at 1 minute and 8.84 (SD = 0.8; median 9) at 5 minutes. Only 5.3% (n = 14) of infants were admitted to the neonatal intensive care unit. This small retrospective study demonstrates similar outcomes to those reported in the current literature. A larger prospective study to carefully describe midwifery care outcomes using a common data collection method is needed to provide evidence for determining the continuation of VBAC as part of midwifery care.

VAGINAL BIRTH AFTER CESAREAN BIRTH: A NATIONAL SURVEY OF U.S. MIDWIFERY PRACTICE

Midwives have been providing care for women choosing vaginal birth after cesarean birth (VBAC) for over 20 years. The 1999 American College of Obstetrician Gynecologist (ACOG) guidelines and recent studies questioning the relative safety of VBAC have raised concerns about continuing to offer this option. As part of an effort to understand VBAC care provided by midwives, this study used a national survey sample to examine practices, scope, and recent changes in the provision of VBAC care. The survey, which included demographic and practice items was mailed in late 2000 to a purposeful sample of 325 midwifery practices. The return rate was 62%. Nearly all (94%) of the responding practices were providing VBAC care, and almost half of them (43%) stated that their ability to do so had changed within the past 2 years secondary to recent studies in the obstetric literature, the 1999 ACOG statement, and concerns from third-party payers. Criteria for offering VBAC are stricter, and consent forms are more extensive. Other changes included the need for additional or more intensive support services, in-house anesthesia, and surgery backup. Midwives continue to provide VBAC care, although with some increased restrictions. This study provides background for future research that will determine how midwifery care affects the rate of successful VBACs.Midwives have been providing care for women choosing vaginal birth after cesarean birth (VBAC) for over 20 years. The 1999 American College of Obstetrician Gynecologist (ACOG) guidelines and recent studies questioning the relative safety of VBAC have raised concerns about continuing to offer this option. As part of an effort to understand VBAC care provided by midwives, this study used a national survey sample to examine practices, scope, and recent changes in the provision of VBAC care. The survey, which included demographic and practice items was mailed in late 2000 to a purposeful sample of 325 midwifery practices. The return rate was 62%. Nearly all (94%) of the responding practices were providing VBAC care, and almost half of them (43%) stated that their ability to do so had changed within the past 2 years secondary to recent studies in the obstetric literature, the 1999 ACOG statement, and concerns from third-party payers. Criteria for offering VBAC are stricter, and consent forms are more extensive. Other changes included the need for additional or more intensive support services, in-house anesthesia, and surgery backup. Midwives continue to provide VBAC care, although with some increased restrictions. This study provides background for future research that will determine how midwifery care affects the rate of successful VBACs.

Global workshops in midwifery competency-based educational methodologies: lessons learned

The Lancet Series on Midwifery and The State of the World’s Midwifery 2014 called on countries to expand the midwifery workforce as a key strategy to improve the health of women and newborns and lower maternal and newborn morbidity and mortality. Well-prepared midwife teachers and preceptors are required to prepare midwives to provide competent, high quality care for women and childbearing families. This article describes the design of competency-based education (CBE) capacity development workshops building on the International Confederation of Midwives’ (ICM) essential competencies and education standards, led by eight English-, Spanish-, and French-speaking CBE Master Educators (MEs). Common content and processes used in three English, one Spanish, and one French workshop are briefly described, noting the influence of participants’ backgrounds, location, and teacher preferences in modifications to common content. As of December 2016, 30 CBE Master Teachers and 22 CBE Teachers have attended a CBE capacity development workshop and, in turn, have provided CBE continuing education (CE) sessions for more than 300 midwife teachers and preceptors in over 20 countries in the Caribbean, Latin America, and Anglophone and Francophone Africa. Lessons learned are shared along with suggestions for next steps in assessment and evaluation of the use of CBE in midwifery education programs.

Small Nations, Large Impact: The Caribbean Regional Midwives Association

This article presents an overview of the emergence of professional midwifery in the Caribbean region, beginning with colonial tradition, and linkages with nursing education and practice. Recent actions taken to strengthen the voice of midwifery as an autonomous profession are then described, including the vision for development of a Caribbean Regional Midwives Association (CRMA), which anticipates recognition as a new member status by the International Confederation of Midwives. CRMA members are engaged in efforts to build individual practitioner capacity in clinical practice and education, through shared activities and resources. CRMA members are also working toward regionalization of a midwifery core curriculum and common standards for regulation.

CLINICAL RESEARCHUse of a Maternity Support Binder for Relief of Pregnancy-Related Back Pain

Objective: To examine the feasibility, acceptability, and effectiveness of a support binder for low back pain in pregnancy. Design: Pilot study, using a prospective, two-group design with repeated measures. Setting: Ambulatory maternity clinic in a tertiary care teaching hospital. Participants: Women of at least 20 weeks gestation with low back pain, but no preexisting back or disc disease. Thirty women assigned to the intervention group and 10 to a comparison group. Interventions: Participants completed a pain assessment at pretest. Intervention participants received a maternity support binder to wear while awake for 2 weeks. At an appointment 2 weeks later, a posttest questionnaire and a taped interview were administered. The comparison group participants received the support binder after the second appointment. Main Outcome Measures: Back pain intensity, duration, and effect on daily activities were assessed using a pain in pregnancy questionnaire. Results: The intervention group had significant reduction in mean pain scores and effect of pain on daily activities, including family, house and yard, recreational, exercise, and sleep. Interaction of group by time was significant for change in pain and effect on family, house and yard, and exercise activities. Conclusion: The use of a support binder for pregnancy-related low back pain is a promising intervention and was well-accepted by the participants.OBJECTIVE To examine the feasibility, acceptability, and effectiveness of a support binder for low back pain in pregnancy. DESIGN Pilot study, using a prospective, two-group design with repeated measures. SETTING Ambulatory maternity clinic in a tertiary care teaching hospital. PARTICIPANTS Women of at least 20 weeks gestation with low back pain, but no preexisting back or disc disease. Thirty women assigned to the intervention group and 10 to a comparison group. INTERVENTIONS Participants completed a pain assessment at pretest. Intervention participants received a maternity support binder to wear while awake for 2 weeks. At an appointment 2 weeks later, a posttest questionnaire and a taped interview were administered. The comparison group participants received the support binder after the second appointment. MAIN OUTCOME MEASURES Back pain intensity, duration, and effect on daily activities were assessed using a pain in pregnancy questionnaire. RESULTS The intervention group had significant reduction in mean pain scores and effect of pain on daily activities, including family, house and yard, recreational, exercise, and sleep. Interaction of group by time was significant for change in pain and effect on family, house and yard, and exercise activities. CONCLUSION The use of a support binder for pregnancy-related low back pain is a promising intervention and was well-accepted by the participants.