American College Of Nurse-Midwives Research Articles

Improvement of Nursing Self-Efficacy for Labor Support Techniques and Implementation of the Coping With Labor Algorithm

There is a 15-fold variation in cesarean birth rates across the United States, yet only 25% can be explained by health risks or objective diagnoses.1,2 This suggests that care practices in hospitals may influence cesarean birth rates. The implementation of care bundles is intended to reduce practice variations. The Promoting Comfort in Labor bundle from the American College of Nurse-Midwives’ Reducing Primary Cesarean Collaborative (RPC) was adopted by our hospital in south central Virginia. Bundle items include provision of continuous labor support ( CLS ), availability of nonpharmacologic tools for comfort, assessment of coping instead of pain, and initial and ongoing education for nurses on nonpharmacologic comfort methods. We used the Nurses’ Care of Women in Labor Survey to guide and evaluate effectiveness of policy changes and education for nurses and implemented the Coping With Labor Algorithm as the unit’s pain-assessment tool. We sent the nursing staff an e-mail and administered the survey using an online survey tool in 2016, 2017, and 2019. All employed labor and delivery nurses were invited to voluntarily participate. The rate of patients receiving CLS and assessment for coping was tracked on a monthly basis. The work was Institutional Review Board–exempt as quality improvement related to participation in the RPC Collaborative. From 2016 to 2019, nursing knowledge of the benefits CLS and confidence in the ability to use CLS techniques increased (p = 1.81E-09, and p = .00000, respectively). From baseline in 2015 to 2019, the rate of patients receiving CLS increased from 3.93% to 4.87% (p = .307). The rate of pain assessment as coping–not coping increased from 44.5% before formal implementation to 79.6% (p = .0000021) after 18 months. Survey-guided education resulted in increased knowledge of outcomes associated with labor support as well as self-efficacy for skill and comfort using labor support techniques. More women received CLS. Use of coping–not coping as the tool to assess labor pain increased. Areas to improve included provider education, better collaboration with doulas, and establishing a program for annual competency assessment for nurses. Additional changes to documentation fields in the health record are needed to make it simpler to consistently document CLS and coping for improved data tracking and improvement.

Promotion of Safe and Effective Physiological Birth in a Tertiary Care Center Through Use of the American College of Nurse-Midwives’ Intermittent Auscultation Bundle

Promotion of Safe and Effective Physiological Birth in a Tertiary Care Center Through Use of the American College of Nurse-Midwives’ Intermittent Auscultation Bundle

Umbilical Cord Practices of Members of the American College of Nurse-Midwives.

Mercer et al surveyed members of the American College of Nurse-Midwives (ACNM) about their umbilical cord clamping practices in 2000. Over the last 20 years, a significant body of research supporting delayed cord clamping (DCC) has been published. The purpose of this study was to learn how midwives today manage the umbilical cord at birth. To better understand the current practices of midwives, in 2017, a national online survey of ACNM members was conducted. A total of 24 questions were asked about DCC, cord milking, specific clinical circumstances, and the presence of policies or guidelines. A total of 5306 surveys were sent with 1106 responses. After applying inclusion criteria, 1050 were available for analysis. Respondents practiced in all settings: home, birth centers, and hospitals. Compared with 2000, a 46% increase in the practice of DCC was identified. In this study, 98% of the participants reported facilitating DCC for full-term vaginal births as compared with 67% in 2000. In addition, 25% practiced DCC for near-term and 65% for preterm neonates. Cord milking was practiced by 37% of participants. When asked about barriers to practicing DCC, 54% of participants identified time pressures to hand off the newborn as the greatest detriment. It was challenging to practice DCC in situations wherein the newborn needed resuscitation or in breech births. Far fewer midwives practice cord milking compared with DCC. The survey results suggest there has been an increase in the practice of DCC over the last 20 years.Cord milking is not as widely practiced as DCC, and respondents were less likely to be convinced by the evidence for cord milking. This speaks to the opportunity for more education for midwives. There is also a need for clinical guidelines that address umbilical cord management when challenging circumstances arise such as breech birth, shoulder dystocia, and the need for resuscitation.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2020.

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the 2020 Recommended U.S. Adult Immunization Schedule for Persons Aged 19 Years and Older. The 2020 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules/index.html,† summarizes ACIP recommendations in two tables and accompanying notes. This 2020 adult immunization schedule has been approved by the CDC Director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. Health care providers are advised to use the tables and the notes together.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger - United States, 2020.

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP)* approved the 2020 Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger. The 2020 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2019 immunization schedule† on the cover page, three tables, and notes found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). Health care providers are advised to use the tables and the notes together. This immunization schedule is recommended by ACIP (https://www.cdc.gov/vaccines/acip/index.html) and approved by the CDC Director, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and, for the first time, the American College of Nurse-Midwives.

Interprofessional Education Between Midwifery Students and Obstetrics and Gynecology Residents: An American College of Nurse-Midwives and American College of Obstetricians and Gynecologists Collaboration.

Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse‐Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team‐Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient‐centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.

A Survey of Midwives' Attitudes Toward Men in Midwifery.

The midwifery profession in the United States demonstrates a significant lack of diversity. The critical need to address the lack of racial and ethnic diversity in the midwifery workforce is well recognized; little attention, however, has been given to gender diversity. This study focused on gender diversity within midwifery, specifically with regard to men who are midwives. Nearly 99% of midwives in the United States are women. No research has previously explored the attitudes of the predominantly female midwifery workforce toward its male members. An invitation to an internet survey was sent to the American College of Nurse-Midwives (ACNM) membership. Quantitative and open-ended questions assessed attitudes toward and experiences with male midwives, whether members thought men belong in the profession, whether gender impacts quality of care, if ACNM should facilitate gender diversification, and whether exposure to male midwives impacts attitudes toward gender diversification. Data analysis of qualitative responses used a qualitative description methodology to identify common themes. Six thousand, nine hundred sixty-five surveys were distributed, and 864 participants completed the survey. Respondents reported beliefs that men belong in midwifery (71.4%), that gender does not affect quality of care (74%), and that ACNM should support gender diversity (72%). Respondents' perspectives revealed 3 dichotomous themes pertaining to the core nature of midwifery and how men fit within the profession: 1) inclusion versus exclusion, 2) empowerment versus protection, and 3) sharing with versus taking from. Often, the same respondent expressed both aspects of the dichotomy simultaneously. This study contributes new information about midwives' attitudes and beliefs toward gender diversity in midwifery in the United States. The values of professionalism, tradition, feminism, protection, and diversification inform participant responses. Findings support efforts toward gender diversification and have implications for implementation in education and practice.

Implementing Delayed Umbilical Cord Clamping in Cesarean Birth Using a Novel Method: A Pilot Study of Feasibility and Safety.

Although delayed cord clamping (DCC) is regarded as the standard of care for all vigorous newborns, those born via cesarean birth are less likely to be afforded this option, especially for longer than 30 to 60 seconds. This pilot study was undertaken to determine whether removal of the placenta before cord clamping to allow for DCC of at least 3 minutes during term, uncomplicated cesarean birth is feasible and without apparent safety issues in order to support a large prospective study on the benefits of this method. Women having a term, uncomplicated cesarean birth who consented to the study were enrolled. Safety was assessed by comparing estimated maternal blood loss, newborn Apgar scores, temperatures, transcutaneous bilirubin levels, need for phototherapy, and neonatal intensive care unit admissions with a matched historical control group of women whose newborns had immediate cord clamping. Feasibility was measured by evaluating staff and maternal comfort with the intervention and by the ability to complete the protocol steps. Seventeen women consented to participate. The protocol was successfully completed in 94% of births. There were no differences in maternal and neonatal safety outcome measures between groups. There was high comfort level with the protocol among staff, and there was universal maternal satisfaction. This method of DCC in cesarean birth appears feasible and safe in this small pilot study and was associated with high maternal satisfaction and clinician comfort. Major organizations such as the American College of Nurse-Midwives and the World Health Organization have called for DCC of up to 3 to 5 minutes in all births, and this simple method has the potential to reach that goal in cesarean birth with minimal apparent risk. A large randomized controlled trial is warranted to determine the neonatal and maternal benefits and safety of this technique compared with a 30-to-60-second delay.

Umbilical Cord Practices of Members of the American College of Nurse‐Midwives

IntroductionThe purpose of this survey of American College of Nurse‐Midwives (ACNM) members was to describe umbilical cord practices of US midwives and to explore possible modifying factors. Contrasting this study with the 2000 survey of ACNM members on umbilical cord clamping by Mercer, Nelson, and Skovgaard, we hypothesized that there would be an increase in utilization of delayed cord clamping at birth by current midwives. The benefits of adequate placental transfusion at birth via delaying cord clamping (DCC) has been well described for both preterm and term neonates. Surveys and observations of provider practice across the globe show inconsistent uptake of the evidence‐based practices of DCC and cord milking. This study provides a 17‐year update to the Mercer et al study and gives the opportunity for current assessment of umbilical cord management by members of ACNM.MethodsThis was a cross‐sectional study of 1050 active members of ACNM who had attended women in labor and birth within 3 years of the survey. Participants were selected using non‐probability, purposive sampling with recruitment through serial e‐mails. Umbilical cord practices were assessed, and related factors were examined using Chi‐square tests and multivariate logistic regression models.ResultsThe overall response rate was 20%. Ninety‐two percent of the midwives performed DCC in this study as compared with 67% in the initial survey done in 2000. Over 50% of the midwives considered DCC in the presence of the following situations: shoulder dystocia, meconium‐stained fluid, and vaginal birth for a non‐reassuring fetal heart rate tracing. Twenty‐six percent said they would delay clamping if resuscitation was required. “I don't know” was the most common response when it came to cord management for breech births or when vacuum or forceps were used. Cord milking was used less frequently than DCC.DiscussionMidwifery use of DCC has expanded since 2000. The use of cord milking is variable with concerns about the validity of the practice. For many participants, uncertainty is present regarding cord clamping in complex clinical situations. The study provides important guidance for addressing knowledge deficits and continual improvement in practice.

Abstracts from Research Forums Presented at the American College of Nurse‐Midwives’ 64th Annual Meeting

Journal of Midwifery & Women's HealthVolume 64, Issue 5 p. 674-674 American College of Nurse-Midwives Abstracts from Research Forums Presented at the American College of Nurse-Midwives’ 64th Annual Meeting First published: 26 September 2019 https://doi.org/10.1111/jmwh.13053Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume64, Issue5September/October 2019Pages 674-674 ACNM Members ACNM Members: Click here to log in RelatedInformation

Estimating the Financial Impact of Reducing Primary Cesareans.

Preventing a primary cesarean birth in nulliparous women with term, singleton, vertex pregnancies (NTSV) is recognized as an important strategy to reduce maternal morbidities and risks to the newborn. Multiple professional organizations are supporting approaches to safely reduce NTSV cesarean rates, including the American College of Obstetricians and Gynecologists; the Society for Maternal-Fetal Medicine; and the Association of Women's Health, Obstetric and Neonatal Nurses. The American College of Nurse-Midwives (ACNM) is leading one such effort as part of its Healthy Birth Initiative: the Reducing Primary Cesareans (RPC) Learning Collaborative. The objective of this study is to estimate the cost savings of a decrease in NTSV cesareans at one hospital participating in the RPC Learning Collaborative. All women giving birth at Baystate Medical Center from October 1, 2016, to March 31, 2017, and their newborns were identified by Medicare Severity Diagnosis Related Group (N = 1747). Total hospital costs were calculated using a resource consumption profile for each of 6 groups: women who had vaginal birth, primary cesarean, and repeat cesarean and their linked newborns. A model was developed to estimate cost differences for the first and second births and overall cost savings. For the NTSV birth, total costs for primary cesarean and newborn care were $5989 higher compared with vaginal birth and newborn care. For the subsequent birth, repeat cesareans and newborn care were $4250 higher compared with vaginal birth. In 2016, 69 primary cesareans were prevented, for an actual cost savings of $413,241. Projecting the prevention of 66 subsequent repeat cesareans would result in additional savings of $280,500, for a total savings of $693,741. Apgar score at 5 minutes and length of stay remained unchanged. Participation in ACNM's RPC Learning Collaborative led to significant savings in hospital costs during the first year without affecting quality metrics. This cost comparison model could be replicated by other hospitals involved in cesarean reduction endeavors.

Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older — United States, 2019

In October 2018, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the Recommended Immunization Schedule for Adults, Aged 19 Years or Older, United States, 2019. The 2019 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules,† summarizes ACIP recommendations in two tables and accompanying notes. The 2019 adult immunization schedule has been approved by the CDC Director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

Factors That Contribute to Excessive Sleepiness in Midwives Practicing in the United States.

Excessive daytime sleepiness is defined as difficulty maintaining wakefulness and alertness during normal waking hours. Excessive daytime sleepiness can lead to clinical errors in health care workers and is associated with dangerous driving. Little is known about the level of daytime sleepiness in midwives in the United States. The purposes of this study, conducted by the American College of Nurse-Midwives (ACNM) Sleep and Safety Taskforce, were first to identify the sleepiness level of US certified nurse-midwives (CNMs) and certified midwives (CMs) by calculating Epworth Sleepiness Scale scores for CNM/CMs in full-scope practice, and then to determine factors that significantly contribute to elevated Epworth Sleepiness Scale scores (>10). Participants in this descriptive, correlational survey study were active ACNM members in full-scope midwifery practice. Descriptive statistics, bivariate analysis, and logistic regression were used for data analysis. Surveys were emailed to all active members of ACNM (N = 4358). A total of 753 (17.3%) survey responses were returned, of which 639 (14.7%) were eligible for analysis. Within this group, 639 (84.9%) self-identified as being in full-scope midwifery practice, and one-fourth (n = 164; 25.7%) had elevated Epworth Sleepiness Scale scores. Duration of work shifts was the only variable found to significantly contribute to differences in Epworth Sleepiness Scale scores, with midwives working shifts longer than 12 hours having higher rates of excessive daytime sleepiness compared with midwives who worked shifts of 12 hours or less. Midwives, midwifery services, and maternity care centers can work together to ensure that clinicians obtain adequate sleep. Reducing excessive sleepiness will contribute to increased safety for midwives, women, newborns, and the general public.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2019.

In October 2018, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the Recommended Immunization Schedule for Adults, Aged 19 Years or Older, United States, 2019. The 2019 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules,† summarizes ACIP recommendations in two tables and accompanying notes. The 2019 adult immunization schedule has been approved by the CDC Director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

Abstracts from Research Forums Presented at the American College of Nurse‐Midwives' 63rd Annual Meeting

Journal of Midwifery & Women's HealthVolume 63, Issue 5 p. 623-623 American College of Nurse-Midwives Abstracts from Research Forums Presented at the American College of Nurse-Midwives' 63rd Annual Meeting First published: 05 October 2018 https://doi.org/10.1111/jmwh.12911Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume63, Issue5September/October 2018Pages 623-623 ACNM Members ACNM Members: Click here to log in RelatedInformation

Collaborative Practice Enriches Teams and Enhances Experiences for Future Providers

To develop a collaborative practice model of care that embraces the contributions of certified nurse-midwives, laborists, residents, midwifery students, and nursing staff, as outlined in the Joint Statement of Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives from the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives.

Development and implementation of a competency-based clinical evaluation tool for midwifery education

BackgroundThe learning goals and evaluation strategies of competency-based midwifery programs must be explicit and well-defined. In the US, didactic learning is evaluated through a standardized certification examination, but standardized clinical competence evaluation is lacking. Description of the toolThe Midwifery Competency Assessment Tool (MCAT) has been adapted from the International Confederation of Midwives’ (ICM) “Essential Competencies” and from the American College of Nurse-Midwives’ (ACNM) “Core Competencies”, with student self-evaluation based on Benner's Novice-to-Expert theory. The MCAT allows for the measurement and monitoring of competence development in all domains of full-scope practice over the course of the midwifery program. Application and evaluation of the toolStrengths of the MCAT are that it provides clear learning goals and performance evaluations for students, ensures and communicates content mapping across a curriculum, and highlights strengths and gaps in clinical opportunities at individual clinical sites and for entire programs. Challenges of the MCAT lie in balancing the number of competency items to be measured with the tedium of form completion, in ensuring the accuracy of student self-evaluation, and in determining “adequate” competence achievement when particular clinical opportunities are limited. ConclusionsUse of the MCAT with competency-based clinical education may facilitate a more standardized approach to clinical evaluation, as well as a more strategic approach to clinical site development and use.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2018.

In October 2017, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018. The 2018 adult immunization schedule summarizes ACIP recommendations in two figures and a table of contraindications and precautions for vaccines recommended for adults, and is intended is to assist health care providers in implementing the current ACIP recommendations for vaccinating adults. The schedule can be found at https://www.cdc.gov/vaccines/schedules.* The full ACIP recommendations for each vaccine are available at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2018 adult immunization schedule has also been approved by the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (https://www.acog.org), and the American College of Nurse-Midwives (http://www.midwife.org). The ACIP-recommended use of each vaccine is developed after an in-depth review of vaccine-related data, including data on disease epidemiology, vaccine efficacy and effectiveness, vaccine safety, feasibility of program implementation, and economic aspects of immunization policy (1).

643: Readability of online patient materials from major obstetrics organizations

To assess the readability of obstetrics-related patient education materials from major obstetric organizations and adherence with national recommendations. All online obstetrics-related patient education materials from the websites of the American Academy of Family Physicians, American College of Nurse-Midwives, American Congress of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and UpToDate were reviewed. Educational materials were excluded if they were not written in English or were not free, the material was only presented in a pictorial, table, video, or hyperlink format, if the content had insufficient text to analyze, or they were not intended for women in the United States. Patient readability was determined using the Flesch-Kincaid Grade Level. To assess adherence with the readability recommendations put forth by the American Medical Association and the National institutes of Health, the percentage of articles written below sixth-grade level was calculated for each organization. The percent of educational materials written below eighth-grade level was also determined given this is the average reading level in the United States. Two hundred and thirty-two obstetrics-related patient education materials from five organizations were reviewed. The median number of patient education materials per organization was 55 (range 12-60). The median reading level was 8.1 (range 2.2-17.2) with 3% and 45% of patient educational materials written below the sixth- and eighth-grade reading level, respectively. Online obstetric patient education materials from most national organizations are written at a level above what is expected for the average patient. These medical organizations provide reliable and accessible information for providers and patients but often deliver content above the recommended level of readability. Ongoing efforts to improve delivery of understandable patient educational materials are needed.

Mixed Methods Evaluation and Teaching with Guatemalan Lay Midwives about Obstetrical Emergencies

Abstract Guatemalan lay midwives are on the front lines of a crisis. The Maternal Mortality Rate (MMR) in Guatemala is 65th highest in the world at 120 deaths per 1,000 births. Part of the problems is not lay midwives attend the majority of births despite lacking knowledge about obstetrical emergencies. Government training programs established in 1955 have not changed lay midwives' knowledge, partially due to culturally insensitively. Government training programs are taught in Spanish with written material, even though most lay midwives are illiterate and speak Mayan dialects. The purpose of this mixed methods study was threefold: to explore lay midwives' knowledge, attitudes and practices about obstetrical emergencies, to evaluate the effect of a culturally sensitive oral teaching in the native language on lay midwives' knowledge of obstetrical emergencies, and to determine if lay midwives retained knowledge from a past, culturally sensitive oral teaching in the native. language about postpartum hemorrhage (PPH). During two weeks in September 2016, 191 lay midwives from more than 30 villages participated in 11 trainings throughout the remote Peten. A one-group pretest posttest design was used for the quantitative evaluation. Focus groups were used for the qualitative evaluation. The Long Table Approach was used to develop a matrix of common themes from focus groups. A checklist from the American College of Nurse Midwives (ACNM) was used to evaluate knowledge of obstetrical emergencies and of PPH before and after the teaching. Results indicated lay midwives retained knowledge about obstetrical emergencies immediately after the culturally sensitive teaching, but not about PPH eight years later. Focus groups themes revealed lay midwives lack education, equipment, support and transportation for addressing obstetrical emergencies. Future teachings should use a similar format to address the needs of illiterate participants in resource-poor settings and should retest participants within a year