Publications

https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13727

Abstract

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. The service model has been infrequently or inconsistently studied in the Unites States and has been narrowly defined and applied to perinatal care. The purpose of this concept analysis was to evaluate the concept of midwifery-led care and expand the definition to guide midwifery practice, research, and health policy. The analysis followed Walker and Avant’s methodology. Three attributes of midwifery-led care were identified: (1) midwife as the lead clinician; (2) person-midwife partnership; and (3) care embodies midwifery philosophy. Antecedents were (1) license to practice as a midwife; (2) a person needing or desiring sexual, reproductive, perinatal, or newborn care; (3) a person with low- or moderate-risk health status; (4) regulations and guidelines that support provision of midwifery care; and (5) reimbursement for services. Consequences of midwifery-led care included (1) improved maternal and neonatal outcomes, (2) patient satisfaction, and (3) reduced health care costs. The presented expanded definition of midwifery-led care is the first to use a systems level approach and explicitly center the person receiving care and the philosophical approach of midwifery care. Application of this definition is needed in theoretical and pragmatic research to classify midwifery-led care and other service models and compare patient- and organization-level outcomes.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.13355

Abstract

Introduction

This is the third national survey about the incidence of midwifery involvement in malpractice litigation, case outcome, methods of coping, and the influence of fear of liability or actual litigation on midwifery practice and professional liability insurance. Incidence of disciplinary action was also included.

Methods

A link to a web-based survey was sent to all American College of Nurse-Midwives members with an active email address in January 2018. Students and associate members were excluded from analysis. Logistic regression was used to identify predictors of involvement in lawsuit.

Results

Of 6199 email links sent, 880 midwives responded (14%). One-third of participants (n = 280, 32%) have been named in at least one lawsuit after a median of 7 years in practice. Claims most often involved intrapartum hospital-based care and resulted from fetal heart rate interpretation. The most common outcome of a case was settlement prior to court or arbitration (n = 117, 42%). Significant predictors of litigation included older age of the midwife and region of practice (increased in Northeastern states, decreased in Midwestern states). Midwives’ most common source of emotional support was their attorney. Only 6% (n = 53) of participants experienced disciplinary action against their state license. Half of the actions by a state governing board were unrelated to a lawsuit.

Discussion

Midwives may experience litigation the longer they are in practice, but there has not been a significant change in the incidence since the previous survey in 2009. More resources and education are needed for midwives to provide adequate peer support to colleagues following adverse events or when named in a lawsuit. Continued education is also needed for midwives regarding types of professional liability insurance, affordability, and how policy terms and limits influence clinical practice.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.13238

Abstract

Induction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual’s health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Current evidence about expected duration of labor following induction, use of the Bishop score to guide induction, and guidance on the use of combination methods for labor induction are reviewed.

Winner: Best Review Article of the Year 2022

https://www.sciencedirect.com/science/article/abs/pii/S0884217521000198

Abstract

Objective

To increase nurse self-efficacy and the use of continuous labor support and to reduce the rate of primary cesareans among nulliparous women with low-risk pregnancies by implementing the Promoting Comfort in Labor safety bundle.

Design

A quality improvement project with a pre–post practice implementation design. This practice change was part of the Reducing Primary Cesarean Learning Collaborative from the American College of Nurse-Midwives.

Setting

A Level II regional hospital in Virginia with more than 2,600 births annually. Births are attended by certified nurse-midwives and physicians.

Participants

Nursing staff on the labor and delivery unit in March 2016 (n = 27), September 2017 (n = 20), and June 2019 (n = 24).

Intervention/Measurements

We updated policies, educated nurses, procured labor support equipment, and modified documentation of care. We measured nurse confidence and skill in labor support techniques with the Self-Efficacy Labor Support Scale over 4 years. We tracked how many women were provided continuous labor support and the primary cesarean birth rate among women who were nulliparous and low risk.

Results

Nurses’ mean self-efficacy scores increased from 76.67 in 2016 to 86.96 in 2019 (p < .001). The proportion of women who were provided continuous labor support increased from a baseline of 4.38% (47/1,074) in January 2015 through March 2016 to 18.06% (82/454) in July through December 2019 (p < .001). The primary cesarean birth rate for nulliparous women with low-risk pregnancies remained stable, at approximately 18% from 2015 to 2019.

Conclusion

Implementation of the Comfort in Labor Safety Bundle improved nurse self-efficacy in labor support techniques and increased the frequency of continuous labor support.

https://ams.midwife.org/product/1071

Details

The third edition of the Midwives’ Guide to Professional Liability, formerly known as the Professional Liability Resource Kit, is produced by the Professional Liability Section of ACNM. This manual provides education and support through what is often a difficult to discuss topic: liability and litigation in midwifery practice. It is intended to be a primer for new midwives and a reference for experienced midwives who may be in career transition seeking insurance-related information. It is also intended as a resource for midwives involved in litigation or experiencing disciplinary action. The first chapter with appendices covers basic liability insurance information and considerations for the varied practice of midwifery. Guidance and risk management strategies for clinical documentation of care and communication with clients after an adverse event follows. The next chapter focuses on support for midwives who have been named in a lawsuit. This information is also applicable for midwives involved in disciplinary action proceedings. The included advice and strategies can also be helpful for midwives who need to support colleagues experiencing trauma related to litigation or disciplinary action. The final chapter gives tools and tips for advocating for full practice authority and liability reform.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.12610

Abstract

The use of exogenous oxytocin to induce or augment labor has increased in recent years. This literature-informed review examines the action of this medication and the potential associated complications, with an evaluation of current professional practice guidelines. A brief history of the use of exogenous oxytocin for labor induction or augmentation is presented. In addition, risk management strategies for the prevention of oxytocin-related adverse outcomes and subsequent litigation are identified.

Winner: Mary Ann Shah New Author Award 2018