Birth Center Research Articles

Investigating the feasibility of implementing the SafeCare parenting program in birthing centers in Haiti.

Child maltreatment is a global issue in need of intervention. This study investigated whether SafeCare, an evidence-based behavioral parenting program to prevent child neglect and physical violence, is desired and feasible to implement in Haiti birthing centers. A total of four focus groups were conducted with 29 birthing center staff and mothers in two birthing centers in Haiti. Staff participants also completed the World Health Organization Readiness Assessment for the Prevention of Child Maltreatment written survey. Focus group findings suggest that SafeCare is a desired program by both caregivers attending the birth center and birth center staff. Findings also showed that the SafeCare curriculum needs cultural adaptations before delivery in Haitian birth centers. We also found that despite contextual challenges that pregnant mothers and birth center staff face in Haiti, birth centers continue to be a place for women to receive pre- and post-natal medical care and weekly education sessions. Findings support that although there are contextual challenges to a SafeCare implementation in Haiti, birthing centers are ideal and feasible locations in which to deliver SafeCare. Birth center networks may be potential settings in which to disseminate and scale evidence-based programs for improved health outcomes for mothers and children.

Parity Moderates the Socioeconomic Predictors of Birth Setting Choice.

The increase in the number of people choosing community birth has raised interest in understanding the factors that influence birth setting choices. This study investigates how parity influences the association between maternal socioeconomic factors and choice of community versus hospital birth. We used 2009-2021 US birth certificate data to identify community births (planned home or birth center births), parity, and maternal characteristics, including Women, Infants, and Children (WIC) program participation, race, ethnicity, educational attainment, marital status, body mass index (BMI), and age. Parity was interacted with each covariate in a multivariable logistic regression model of birth setting. Among 26,526,010 eligible births, 58% were to multiparous mothers, with 1.9% occurring in a birth center or at home. For most maternal characteristics, associations with community birth were stronger in the multiparous group compared to the nulliparous group. For example, being married was associated with greater odds of community birth in both groups, but the strength of this association was greater within the multiparous group (odds ratio 4.00 vs. 1.94, interaction p < 0.001). The same pattern (stronger association with community birth in the multiparous group than in the primiparous group) was observed for race/ethnicity, educational attainment, and WIC participation, all of which were associated with lower odds of community birth. This study shows that parity significantly moderates associations between maternal socioeconomic characteristics and birth setting, implying studies of decision-making in this context should purposively stratify samples and analyses by parity.

Routine Transvaginal Ultrasound at the Time of the Anatomy Scan: To Do or Not To Do?

There are no universal guidelines for transvaginal ultrasound (TVUS) at the time of the anatomy scan. TVUS can provide information on placental location and cervical length (CL) but may lead to more interventions. As a quality assurance initiative, a universal TVUS (UTVUS) protocol at the time of the anatomy scan was started at our institution. This study was conducted to assess whether there was a decrease in preterm birth (PTB), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission once UTVUS was implemented. This was a retrospective cohort study performed on singleton gestations from February 2021 to January 2022. In the first 6 months of the study period, patients only had TVUS based on risk factors (pre group). In the second half of the study period, UTVUS was implemented at the time of the anatomy scan (post group). A total of 2,118 patients were included in the study. There were 1,037 patients in the pre group, of which 161 underwent TVUS based on high-risk factors (history of the cervical procedure, history of prior PTB, and placenta appearing low lying or cervix appearing short on abdominal ultrasound). The post group/UTVUS included 1,081 patients. Patients in the pre group had statistically significantly earlier gestational age at first TVUS (p < 0.0001), were less likely to have had a prior PTB <36 weeks (p = 0.03), and were more likely to have a history of cervical procedure (p = 0.0006) than patients in the post group. There was an increased use of vaginal progesterone in the UTVUS with 33 patients (as opposed to 10 patients in the pre group; p = 0.0007). The proportion of patients with PTB, PPH, or NICU admission did not significantly differ between the two groups even after adjusting for cofounders (p > 0.05). Our data show that UTVUS did not decrease the adverse pregnancy outcomes. In addition, the implementation of UTVUS adds more discomfort for a patient, more time to the patient's scan, and is an additional cost. Therefore, surveillance by abdominal ultrasound and adding TVUS based on risk factors may be a reasonable alternative. · UTVUS showed no difference between CLs.. · There is not sufficient evidence to conclude a difference between PTB or PPH in the two groups.. · There was significantly more placenta previa diagnosed in the post group, yet most resolved..

Advanced Birth Centers and the Effect on Maternity Care

This Viewpoint discusses advanced birth centers and their effect on maternity care.

The Contribution of Hypertensive Disorders of Pregnancy to Neonatal Unit Admissions and Iatrogenic Preterm Delivery at < 34+0 Weeks' Gestation in the UK: A Population-Based Study Using the National Neonatal Research Database.

The objectives of this study were to (i) quantify the contribution of maternal hypertensive disorders of pregnancy (HDP) to iatrogenic preterm birth (PTB) and neonatal unit (NNU) admissions < 34+0 weeks and (ii) describe short-term population-level outcomes for HDP infants, exploring ethnic disparities and comparing outcomes by HDP exposure. Retrospective population-based study using the National Neonatal Research Database. England and Wales. Infants born < 34+0 weeks and admitted to NNU 2012-2020. Descriptive statistics, linear and logistic regression models to compare outcomes between groups. Survival to discharge with/without comorbidity. 122 228 infants met inclusion criteria. Where collected, 49 839/114 164 (43.7%, 95% CI 43.4%-43.9%) of infants had an iatrogenic PTB. HDP was recorded in 16 510/122 228 (13.5%) of all infants and 13 560/49 839 (27.2%) of iatrogenic PTBs. HDP and/or foetal growth restriction (FGR) were recorded in 24 124/49 839 (48.4%) of iatrogenic PTBs. Singleton HDP infants < 10th BWC had ≥ 90% survival to discharge from 28 weeks' gestation, versus from 26 weeks' gestation for those born ≥ 10th BWC. In extreme preterm HDP infants (< 27 weeks), 27.3% of infants < 10th BWC died compared to 15.2% of those ≥ 10th BWC. Survival without comorbidity was ≥ 90% from 32 weeks' gestation in HDP infants across BWC. These contemporaneous population-level data show that almost one in two PTB < 34+0 weeks' gestation are iatrogenic, with HDP and/or FGR being the major contributors to iatrogenic prematurity. This has substantial implications for strategies to reduce preterm birth in the UK and internationally. The data further inform antenatal and at-birth counselling of HDP-exposed infants.

Tailoring midwifery care to women's needs in early labour: The cultivation of relational care in free-standing birth centres

AimTo understand and interpret the lived experience of newly qualified midwives in their first year in a free standing birth centre caring for women in early labour. BackgroundWomen who present in hospital labour wards in early labour are encouraged by hospital staff to go home. This leaves women to navigate early labour without professional care, leaving them on their own to manage the transition from early to active labour. However, some women request care for this transition. DesignThis is a Heideggerian hermeneutic phenomenology study. MethodsThree unstructured interviews were conducted with 15 newly qualified midwives in their first year working in a free-standing birth centre. This paper focuses on the research participants’ lived experience offering care to women in early labour. The study was conducted from 2021-2024. FindingsThree themes were revealed in analysis: “Paving the way into labour”: Tailoring care to women's needs in early labour; “Perhaps it was intuition.”: Experiencing deeper knowing as a newly qualified midwife; and “She locked the door and wouldn't let me in.”: Navigating uncomfortable situations in early labour. ConclusionsThe lived experience of newly qualified midwives offering care in early labour shows potential for midwives to build trusting relationships with women in this phase. Relevance to clinical practicePrioritizing relational care over interventions in early labor can enhance trust and confidence between midwives and birthing women, particularly in settings where policies discourage early admissions. IssueWomen presenting in hospital labour wards in early labour who are sent home are often discouraged, feeling that their concerns and embodied experiences have not been heard. What is already knownWhen labouring women are admitted to hospitals in early labour, they are prone to receive a cascade of interventions. What this paper addsWhen newly qualified midwives began working in free-standing birth centres, they acquired skills and knowledge to accompany women in early labour who requested care. Relational care in early labour builds women's trust in their ability to give birth and does not rely on interventions to augment labour.

Severe adverse maternal and neonatal outcomes according to the planned birth setting being midwife-led birth centers or obstetric-led units.

The establishment of midwife-led birth centers (MLBCs) is still being debated. The study aimed to compare severe adverse outcomes and mode of birth in low-risk women according to their birth planned in MLBCs or in obstetric-led units (OUs) in France. We used nationwide databases to select low-risk women at the start of care in labor in MLBCs (n = 1294) and in OUs (n = 5985). Using multilevel logistic regression, we compared severe adverse maternal and neonatal morbidity as a composite outcome and as individual outcomes. These include severe postpartum hemorrhage (≥1000 mL of blood loss), obstetrical anal sphincter injury, maternal admission to an intensive care unit, maternal death, a 5-minute Apgar score <7, neonatal resuscitation at birth, neonatal admission to an intensive care unit, and stillbirth or neonatal death. We also studied the mode of birth and the role of prophylactic administration of oxytocin at birth in the association between birth settings and severe postpartum hemorrhage. Severe adverse maternal and neonatal outcome indicated a slightly higher rate in women in MLBCs compared to OUs according to unadjusted analyses (4.6% in MLBCs vs. 3.4% in OUs; cOR 1.36; 95%CI [1.01-1.83]), but the difference was not significant between birth settings after adjustment (aOR 1.37 [0.92-2.05]). Severe neonatal morbidity alone was not different (1.7% vs. 1.6%; aOR 1.17 [0.55-2.47]). However, severe maternal morbidity was significantly higher in MLBCs than in OUs (3.0% vs. 1.9%; aOR 1.61 [1.09-2.39]), mainly explained by higher risks of severe postpartum hemorrhage (2.4 vs. 1.1%; aOR 2.37 [1.29-4.36]), with 2 out of 5 in MLBCs partly explained by the low use of prophylactic oxytocin. Cesarean and operative vaginal births were significantly decreased in women with a birth planned in MLBCs. In France, 3 to 4% of low-risk women experienced a severe adverse maternal or neonatal outcome regardless of the planned birth setting. Results were favorable for MLBCs in terms of mode of birth but not for severe postpartum hemorrhage, which could be partly addressed by revising practices of prophylactic administration of oxytocin.

Metformin and small for gestational age babies: findings of a randomised placebo-controlled clinical trial of metformin in gestational diabetes (EMERGE).

Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes because of suboptimal glucose management and glucose control and excessive weight gain. Metformin can offset these factors but is associated with small for gestational age (SGA) infants. We sought to identify risk factors for SGA infants, including the effect of metformin exposure on SGA status. In this prespecified secondary analysis of the EMERGE trial, which evaluated the effectiveness of metformin vs placebo in treating GDM and found reduced gestational weight gain and longer time to insulin initiation with metformin use, we included women with a live-born infant and known infant birthweight and gestational age at delivery. We compared the numbers of SGA infants in both groups and explored baseline predictive factors to help identify those at highest risk of delivering an SGA infant. Baseline maternal characteristics were similar between SGA and non-SGA pregnancies. On multivariable-adjusted regression, no baseline maternal variables were associated with SGA status. Mothers of SGA infants were more likely to develop pre-eclampsia or gestational hypertension (18.2% vs 2.0%, p=0.001; 22.7% vs 5.4%, p=0.005, respectively); after multivariable adjustment, pre-eclampsia was positively associated with SGA status). Among SGA pregnancies, important perinatal outcomes including preterm birth, Caesarean delivery and neonatal care unit admission did not differ between the metformin and placebo groups (20.0% vs 14.3%, p=1.00; 50.0% vs 28.6%, p=0.25; 13.3% vs 42.9%, p=0.27, respectively). Pre-eclampsia was strongly associated with SGA infants. Metformin-exposed SGA infants did not display a more severe SGA phenotype than infants treated with placebo. Clinical Trials.gov NCT02980276; EudraCT number: 2016-001644-19.

“It's my Home away from Home:” A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care

ProblemThe high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality. BackgroundBirth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes. AimThis study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting. MethodsWe employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning. FindingsTwelve women participated in the study. Five themes emerged that described participants’ decision-making processes: 1) Stepping Away from “the System,” 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process. DiscussionThe decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment. ConclusionPrioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people.

Midwives' support for parents following stillbirth: How they practise and resources they need from a phenomenological perspective.

To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth. Qualitative study based on Gadamer's hermeneutic phenomenology. This study was conducted with midwives (n = 18) at the birth unit of a third-level public hospital in Jaén (Spain) in 2023. Personal semi-structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming. Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided. Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them. The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system. WHAT PROBLEM DID THE STUDY ADDRESS?: The midwives´ experiences in cases which end with the delivery of a stillborn. WHAT WERE THE MAIN FINDINGS?: Each action of the midwife is as important as the availability of resources to offer the most appropriate care. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: In each woman who receives the care of a midwife who attends the birth of a stillborn. COREQ checklist. No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience.

Trends and adverse pregnancy and birth outcomes associated with stimulant-related disorder diagnosis.

Stimulant-related disorders (SRD), or the continued misuse of illicit or prescribed stimulants, during pregnancy can have adverse health effects for mothers and infants. This study aimed to measure prevalence and trends of SRD diagnosis in pregnancy, and associations between SRD diagnosis and adverse maternal and infant health outcomes, among pregnant individuals in California. Retrospective cohort study. California, USA. Pregnant individuals from the Study of Outcomes in Mothers and Infants (SOMI) with singleton live births between 2012 and 2020 (n = 3 740 079). SRD diagnosis (excluding cocaine) and maternal (gestational diabetes, gestational hypertension [gHTN], severe maternal morbidity [SMM]) and infant (very preterm birth [gestational age <32 weeks], preterm birth [gestational age 32-37 weeks], neonatal intensive care unit [NICU] admission, small for gestational age [SGA]) outcomes were classified using International Classification of Disease (ICD) codes and vital statistics. Risk ratios were estimated with modified Poisson log linear regression that accounted for sibling pregnancies. Covariates included maternal sociodemographic characteristics, mental and physical health problems, nicotine use and co-occurrence of other diagnosed substance use disorders. Bias analyses were conducted to address unmeasured confounding and exposure misclassification. SRD diagnosis among pregnant individuals increased from 2012 to 2020 (554 to 748 per 100 000 births). SRD diagnosis was associated with an increased risk of SMM (adjusted risk ratio [aRR] = 2.3; 95% confidence interval [CI] = 2.2-2.5), gHTN (aRR = 1.8; 95% CI = 1.7-1.9), very preterm birth (aRR = 2.2, 95% CI = 2.0-2.5), preterm birth (aRR = 2.1, 95% CI = 2.1-2.2) and NICU admission (aRR = 2.0, 95%CI = 1.9-2.0), and a decreased risk of gestational diabetes (aRR = 0.8; 95% CI = 0.8-0.9). SRD diagnosis was not associated with infants born SGA. Findings were generally robust to unmeasured confounding and misclassification of diagnosis. Stimulant-related disorder diagnosis during pregnancy appears to be associated with an increased risk for select adverse maternal and infant health outcomes including severe maternal morbidity, gestational hypertension, very preterm birth, preterm birth and neonatal intensive care unit admission.

Perinatal Environmental Risks for Eosinophilic Esophagitis: A Systemic Review and Meta-Analysis.

There are limited data on the association of eosinophilic esophagitis (EoE) and environmental risk factors. The aim of this study was to determine the potential associations between perinatal risk factors and EoE. A search was conducted for relevant studies published up to December 12th, 2023, using MEDLINE, EMBASE, Scopus, Web of Sciences, and Cochrane databases. Risk ratioswith the 95% confidence interval (CI) were estimated using a random-effects model. Case-control or cohort studies that determined perinatal environmental factors within the first year of life and their association with EoE were included. Six case-control studies were included in the analysis. Six studies (2,087 EoE and 6,786 controls) were included for risk of infant antibiotic use with a pooled risk ratio of 1.30 (95%CI: 1.11-1.52,I2 = 76%), and five studies were included for cesarean section with a pooled risk ratio of 1.22 (95%CI: 1.10-1.34, I2 = 5%). There were three studies for breastfeeding with a pooled risk ratio of 1.07 (95%CI:1.00-1.15, I2 = 0%); five studies were included for preterm birth with a pooled risk ratio of 1.52 (95%CI: 1.14-2.04, I2 = 48%). There were three studies for neonatal intensive care unit admission with a pooled risk ratio of 1.75 (95% CI: 1.41-2.18, I2 = 0%). Publication bias was found between EoE and infant antibiotic use and cesarean section, but not for EoE and preterm birth, neonatal care unit admission, or breastfeeding. This meta-analysis suggests a weak association between antibiotic use during the first year of life, cesarean section, preterm birth, and neonatal intensive care unit admission and a possible risk of EoE. Further studies are warranted to confirm these findings as they may be indirect associations rather than causal.

Interpregnancy interval and adverse perinatal outcomes: A within-individual comparative method.

Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between-individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within-individual comparative analyses. We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB, <37 weeks' gestation), small-for-gestational-age (SGA, <10th percentile of sex-specific birthweight for gestational age), low birthweight (LBW, <2,500 g), and neonatal intensive care unit (NICU) admission. Point and 95% confidence interval (CI) estimates were adjusted for factors that vary across pregnancies within individuals. CIsdid not unequivocally support either an increase or a decrease in the odds of PTB (adjusted odds ratio [aOR]: 1.31, 95% CI: 0.87, 1.96), SGA (aOR: 0.81, 95% CI: 0.51, 1.28), LBW (aOR: 1.59, 95% CI: 0.90, 2.80), or NICU admission (aOR: 0.96, 95% CI: 0.66, 1.40) for an IPI<6 months compared to 18-23-months IPI (reference), and neither did the CIs for the aOR of IPIs of 6-11 and 12-18 months compared to the reference. In contrast, an IPI≥24 months was associated with increased odds of LBW (aOR: 1.66, 95% CI: 1.03, 2.66 for 24-29 months; aOR: 2.27, 95% CI: 1.21, 4.29 for 30-35 months; and aOR: 2.09, 95% CI: 1.17, 3.72 for ≥36 months). Using a within-individual comparative method, we did not find evidence that a short IPI compared to the recommended IPI of 18-23 months was associated with increased odds of PTB, SGA, LBW, and NICU admission. IPI ≥ 24 months was associated with increased odds of delivering anLBW infant.

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Tongue-tie in the Neonatal Intensive Care Unit Compared to Healthy Newborns.

We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC). Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue-tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared. Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre-frenotomy (p < 0.01). Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue-tie can be one critical intervention to move these patients closer to oral feeding and discharge to home. Level 3 Laryngoscope, 2024.

Intrapartum fetal monitoring practices in Norway: A population-based study

ObjectiveTo describe intrapartum fetal monitoring methods used in all births in Norway in 2019–2020, assess adherence to national guidelines, investigate variation by women’s risk status, and explore associations influencing monitoring practices. MethodsA nationwide population-based study. We collected data about all pregnancies with a gestational age ≥ 22 weeks during 2019–2020 from the Medical Birth Registry of Norway. We used descriptive analyses, stratified for risk status, to examine fetal monitoring methods used in all deliveries. Univariable and multivariable logistic regression models were used to determine factors associated with monitoring with cardiotocography (CTG) in low-risk, straightforward births. ResultsIn total, 14 285 (14%) deliveries were monitored with only intermittent auscultation (IA), 46214 (46%) with only CTG, and 33417 (34%) with IA and CTG combined. Four percent (2 067/50 533) of women with risk factors were monitored with IA only. Half (10589/21 282) of the low-risk women with straightforward births were monitored with CTG. Maternal and fetal characteristics, size of the birth unit and regional practices influenced use of CTG monitoring in this group. ConclusionsMost births are monitored with CTG only, or combined with IA. Half the women with low-risk pregnancies and straightforward births were monitored with CTG although national guidelines recommending IA.

Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model: A Sequential Explanatory Mixed-Methods Study

BackgroundIn recent decades, medical supervision of the labor and delivery process has expanded beyond its boundaries to the extent that in many settings, childbirth has become a medical event. This situation has influenced midwifery care. One of the significant barriers to midwives providing care to pregnant women is the medicalization of childbirth. So far, the policies and programs of the Ministry of Health to reduce medical interventions and cesarean section rates have not been successful. Therefore, the current study aims to be conducted with the purpose of “Designing a Midwife-Led Birth Center Program Based on the MAP-IT Model”.Methods/designThe current study is a mixed-methods sequential explanatory design by using the MAP-IT model includes 5 steps: Mobilize, Assess, Plan, Implement, and Track, providing a framework for planning and evaluating public health interventions in a community. It will be implemented in three stages: The first phase of the research will be a cross-sectional descriptive study to determine the attitudes and preferences towards establishing a midwifery-led birthing center focusing on midwives and women of childbearing age by using two researcher-made questionnaires to assess the participants’ attitudes and preferences toward establishing a midwifery-led birthing center. Subsequently, extreme cases will be selected based on the participants’ average attitude scores toward establishing a midwifery-led birthing center in the quantitative section. In the second stage of the study, qualitative in-depth interviews will be conducted with the identified extreme cases from the first quantitative phase and other stakeholders (the first and second steps of the MAP-IT model, namely identifying and forming a stakeholder coalition, and assessing community resources and real needs). In this stage, the conventional qualitative content analysis approach will be used. Subsequently, based on the quantitative and qualitative data obtained up to this stage, a midwifery-led birthing center program based on the third step of the MAP-IT model, namely Plan, will be developed and validated using the Delphi method.DiscussionThis is the first study that uses a mixed-method approach for designing a midwife-led maternity care program based on the MAP-IT model. This study will fill the research gap in the field of improving midwife-led maternity care and designing a program based on the needs of a large group of pregnant mothers. We hope this program facilitates improved eligibility of midwifery to continue care to manage and improve their health easily and affordably.Ethical codeIR.MUMS.NURSE.REC. 1403. 014.

Evaluation of the Newborn Screening Pilot for Sickle Cell Disease in Suriname Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework.

The early detection of sickle cell disease (SCD) is vital to reduce mortality among affected children. Suriname currently lacks a newborn screening programme (NSP) for SCD. We performed a pilot programme to evaluate the scalability of such an initiative. Dried blood spots were collected from five birth centres and subjected to electrophoresis analysis. The programme scalability was evaluated using the non-adoption, abandonment, scale-up, spread, and sustainability framework. Challenges across six domains (illness, technology, value proposition, adopter system, organisation, and societal system), were categorised hierarchically as simple 😊, complicated 😐, or complex 😢. It has been proven that implementing programmes with mainly complicated challenges is difficult and those in mainly complex areas may be unachievable. SCD was detected in 33 of 5185 (0.64%) successfully screened newborns. Most of the domains were classified as simple or complicated. Disease detection and technology suitability for screening in Suriname were confirmed, with favourable parental acceptance. Only minor routine adjustment was required from the medical staff for programme implementation. Complex challenges included a reliance on external suppliers for technical maintenance, ensuring timely access to specialised paediatric care for affected newborns, and securing sustainable financial funding. Scaling up is challenging but feasible, particularly with a targeted focus on identified complex challenges.

A case study analysis of a successful birth center in northern Uganda.

Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high-quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000-a rate that is lower than many high-resource countries. This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software. Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence-informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available. This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality.

Neonatal morbidity and mortality in birth centers in the United States 2018-2021: An observational study of low-risk birthing individuals.

Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed. Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics. The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; p-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; p-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; p-value < 0.001), Apgar score < 4 (aOR 0.814, 95% CI [0.638, 1.039], p-value 0.099), Apgar score < 7 (aOR 1.075, 95% CI [0.979, 1.180], p-value 0.130), ventilation >6 h (aOR 0.349; [0.281,0.433], p-value < 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], p-value < 0.001). Birth centers had higher odds of assisted neonatal ventilation for <6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], p-value < 0.001). Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores < 4, and intensive care admission were less likely to occur in birth centers.