Tekoa L. King

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

OBJECTIVEnMore 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.nnnSTUDY DESIGNnWe 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.nnnRESULTSnThere 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.nnnCONCLUSIONnPlanned 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.

Evidence‐Based Approaches to Managing Nausea and Vomiting in Early Pregnancy

Nausea and vomiting in pregnancy is a continuum that ranges from mild discomfort to significant morbidity. Systematic assessment with the use of the Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) index and timely treatment using evidence-based protocols can decrease the time that many women spend using treatment recommendations that are inadequate. This article reviews the epidemiology of nausea and vomiting in pregnancy, use of the PUQE index, and the evidence for specific nonpharmacologic and pharmacologic treatment regimens. A protocol for clinical management is presented.

The 2008 National Institute of Child Health and Human Development report on fetal heart rate monitoring.

Standardization of fetal heart rate (FHR) interpretation and management guidelines has been elusive, and no system is currently widely accepted in the United States. The recently summarized 2008 Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop proposed a three-tier system of interpretation of FHR patterns, but left management recommendations to the professional associations. The middle tier, called indeterminate Category II, which contains the variant FHR patterns seen most frequently, is vast and heterogeneous. We propose that this category can be subcategorized at least tentatively, based on evidence available from previously published studies. Such subcategorization will allow the organizations proposing management recommendations to more readily set up guidelines for graded interventions and clinical responses to the spectrum of FHR patterns, with the aim of minimizing fetal acidemia without excessive obstetric intervention. Such management algorithms will need to be tested by appropriately designed clinical studies.

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.

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.

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.

The Use of Herbs by California Midwives

OBJECTIVEnTo 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.nnnDESIGN/SETTING/PARTICIPANTSnCross-sectional survey/California/Practicing midwives.nnnMETHODSnA 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).nnnRESULTSnOf 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.nnnCONCLUSIONnLicensed 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.

Nitrous oxide for labor pain: is it a laughing matter?

In the second season of the hit television series “Call the Midwife,” the midwives who attend home births in East London in 1958 are introduced to what they call “gas and air” or 50%/50% nitrous oxide/oxygen (N2O/O2) mix. Soon all the expectant “mums” in East London start using it, and the midwives

Antenatal corticosteroids at the beginning of the 21st century.

Corticosteroids administered to women in preterm labor are the standard of care for reducing neonatal morbidity and mortality associated with prematurity. These agents promote lung development and reduce the incidence of neonatal intraventricular hemorrhage. Several studies have investigated the method by which fetal lung fluid is cleared after birth. This exploration resulted in the elucidation of the Starling equation or the hypothesis that fluid filtration through capillary membranes is dependent on the balance between the pressure blood places on the capillary membranes and the osmotic pressure of the membranes. The clinical observation that a neonate experiences a vaginal squeeze during a vaginal birth may be important, but it can account for only a small percentage of the lung fluid absorbed. Perhaps more importantly, amiloride-sensitive sodium transport channels (ENaCs) have emerged as key factors in the movement of alveolar fluid from the lung into the vascular system. Several potential clinical applications have been developed from this new knowledge about the physiology of lung fluid clearance at birth. Neonates born late preterm or at term by elective cesarean before the onset of labor are more likely to develop respiratory distress than those born vaginally. Based on the mechanism of action of antenatal corticosteroids, these drugs may be beneficial in the clearance of fetal lung fluid in this population. This article reviews how fetal lung fluid is cleared; the pharmacologic effects of corticosteroids on the fetus; and the risks, benefits, and controversies associated with corticosteroid use.

The evolution of a journal.

s I step down, it is my pleasure and honor to introduce rances E. Likis, CNM, NP, DrPH, as the 13th Editorn-Chief in the history of the Journal of Midwifery & omen’s Health. Francie has been in every editorial role e have: deputy editor, associate editor, contributing ditor for journal reviews, and peer reviewer. This ournal will continue to grow under her leadership. rancie will introduce herself and her vision later on in his editorial. But transitions are an opportune time for eflection, and I have been thinking a lot about what I ant to say in my last editorial as Editor-in-Chief. For the last 6 years, every time I opened a new anuscript I thought, What is the purpose of JMWH? oes this manuscript say something CNMs/CMs and ther women’s health care providers need or want to now about? Every time I made a decision to accept or eject a manuscript, I thought, What is the responsibility f this journal to ‘give voice’ to this author, this idea, or his news? Could this article help further the growth of he midwifery profession? You probably skim through the table of contents every months and look for items meaningful to you. In ontrast, every aspect of this journal, every page in each ssue, has lived with us every day, just as it “lived” for very past and every future editor. . . . every day. Thereore, more than anything else, I want to share how this ournal is a living, growing, evolving, essential reflection f our profession. And through that lens, I want you to ee why I believe midwifery is thriving. As we have moved into the 21st century, both the rofession and the journal have integrated new technoogical realities. Midwives in clinical practice use PDAs o access evidence-based guidelines. We have learned ew gynecologic skills to help give women more reprouctive choice, and we have adapted computer technolgies to expand access to midwifery education. JMWH n