Birth Settings in America


Book Description

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.







Understanding Differing Rates of Certified Nurse Midwife-attended Births in Wisconsin


Book Description

Research has found that Certified Nurse Midwives (CNMs) produce as good or better outcomes, including infant mortality rates and maternal mortality rates, as physicians, particularly for women from socially disadvantaged groups. Yet midwifery care is still widely unavailable in counties across the United States. While some research examines how state-level polices impact access to midwives, this study aims to understand within-state variation. Why are some medical facilities within a state able to sustain a rate of about 50% of CNM attended births, with a state rate of only 12%? A qualitative multiple-case-study design was used to examine what may have contributed to the high rate of CNM attended births at two sites serving different regions in Wisconsin. Interviews were conducted with 34 employees including CNMs, physicians, nurses, administrators, and gatekeepers. Interviews explored participants' beliefs and understanding about CNM's practice model, policies, and relationships between professions. Transcripts were analyzed using direct content analysis. Results: First, more exposure to CNMs appears to affect positive regard of CNM care by colleagues. Second, a positive workplace was consistently reported at both sites across professions. Third, CNMs report significant input into their practice policies. Fourth, while colleagues described an overall positive impression of CNM care, there was a lack of demonstrated understanding of the CNM model of care. Fifth, CNMs reported a desire for more autonomy. Sixth, all professions reported a current lack of competition for patients. Hospitals and clinics may successfully increase access to CNMs by building a collaborative work environment.




The World Health Report 2006


Book Description

The 2006 World Health Report focuses on the chronic shortages of doctors, midwives, nurses and other health care support workers in the poorest countries of the world where they are most needed. This is particularly true in sub-Saharan Africa, which has only four in every hundred global health workers but has a quarter of the global burden of disease, and less than one per cent of the world's financial resources. Poor working conditions, high rates of attrition due to illness and migration, and education systems that are unable to pick up the slack reflect the depth of the challenges in these crisis countries. This report considers the challenges involved and sets out a 10-year action plan designed to tackle the crisis over the next ten years, by which countries can strengthen their health system by building their health workforces and institutional capacity with the support of global partners.




Careers in Midwifery


Book Description

SOME SAY MIDWIFERY IS THE world's oldest profession. You likely know what midwives do: they deliver babies. They have been doing that since the beginning of human history. Throughout the millenniums, midwifery knowledge and skills were passed down from one generation of women to the next. By contrast, today's midwives are highly trained and licensed healthcare professionals with the expertise to help women stay healthy before, during, and after pregnancy. They share a holistic philosophy of care that encourages a more natural approach to childbirth, free of medications, incisions, and other invasive procedures. There are two basic categories for American midwives: certified nurse midwives (CNMs) and direct-entry midwives (DMs). The main difference is the level and type of training. CNMs are registered nurses (RNs) who have earned a graduate level degree in midwifery. Their nursing training allows them to provide a broad range of services. A CNM can be a primary caregiver, managing a woman's health throughout her lifespan from adolescence through menopause. In fact, CNMs only spend about 10 percent of their work time on dealing with childbirth. DMs are also highly trained, but they are not nurses. They are limited by what they can do and therefore, focus solely on the childbearing process. The vast majority of midwives are CNMs. Though the requirements and procedures vary, every state licenses CNMs. Most work in hospitals and that is also where most babies delivered by midwives are born. By contrast, DMs account for only 10 percent of midwives. A number of states prohibit their practice and they rarely work in hospitals. They largely work in settings outside of formal medical care facilities, including women's homes. In many areas of the country, they are welcomed because their services are badly needed.Both CNMs and DMs are in demand and the future looks exceptionally good. Women of all backgrounds are rejecting the outdated notion that childbirth is a pathology that requires medical intervention. The result is a projected increase of over 30 percent in jobs for midwives in the coming years, which is four times greater than the average job growth rate for all occupations combined. Demand will be higher in inner cities and rural areas, but opportunities are everywhere. The level of salaries typically follows the level of demand and midwifery is no exception. American midwives earn a comfortable living with a median annual income of $100,000. Individual earnings vary by location, training, work setting, and other factors. The salary range of the majority is between $80,000 and $120,000. Midwifery is an ancient practice that combines old wisdom and current scientific research. It is a messy business that can be exhausting and stressful at times. Bringing beautiful new babies into the world is a vocation that offers unique rewards to those who answer the call.










Outcomes of Low Risk Births


Book Description




Parallel Online Survey of Two Professional Midwifery Groups in One U.S. State


Book Description

There currently exist little data regarding the nature and scope of midwifery practice in the United States. This case was based on a state-wide survey of two different midwifery clinicians in the state of Texas, USA, both certified nurse-midwives and professional midwives. Midwives from these two professional groups are certified by two different certifying bodies and are licensed by two different state boards, but have some overlapping professional functions. This research developed two different parallel surveys for distribution to Texas certified nurse-midwives (N = 449) and certified professional midwives (N = 212) using the REDCap data management system hosted by the University of Colorado. The workforce survey was adapted for use in this research and included approximately 112 items across eight areas; where possible, identical items were used. A total of 143 certified nurse-midwives out of 449 responded to the survey for a response rate of 31.8%; a total of 75 certified professional midwives out of a total of 212 responded for a response rate of 35.4%. Although there were limitations in this Internet survey research, use of the REDCap data management system was a valuable and useful tool in collecting and comparing data between two parallel midwifery groups. The case study provides discussion of the practical aspects of surveying two professional groups and details important considerations for successful execution of a survey. Lessons learned in the conduct of this research are described.