Birth Settings Research Articles

What influences women's experiences of childbirth in Flanders? – A quantitative cross-sectional analysis of the Babies Born Better survey

ObjectiveLabour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium. DesignA cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders. Participants1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018. FindingsThe majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362–0.817) and post term birth (OR 0.664, 95% CI 0.462–0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 – 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 – 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218–0.463), an instrumental birth (OR 0.318, 95% CI 0.218–0.463) or a planned- (OR 0.349, 95% CI 0.205–0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109–0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth. Key conclusionsThe majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences. Implications for practiceWomen's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia

BackgroundDespite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. ObjectiveThis study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. MethodsWe used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model – representing standard public hospital care, and a counterfactual model – representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. ResultsIn our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). ConclusionA considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.

Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis

BackgroundPreventing postpartum depression (PPD) is the most common self-reported motivation for human maternal placentophagy, yet very little systematic research has assessed mental health following placenta consumption. Our aim was to compare PPD screening scores of placenta consumers and non-consumers in a community birth setting, using propensity score matching to address anticipated extensive confounding.MethodsWe used a medical records-based data set (n = 6038) containing pregnancy, birth, and postpartum information for US women who planned and completed community births. We first compared PPD screening scores as measured by the Edinburgh Postpartum Depression Scale (EPDS) of individuals who consumed their placenta to those who did not, with regard to demographics, pregnancy characteristics, and history of mental health challenges. Matching placentophagic (n = 1876) and non-placentophagic (n = 1876) groups were then created using propensity scores. The propensity score model included more than 90 variables describing medical and obstetric history, demographics, pregnancy characteristics, and intrapartum and postpartum complications, thus addressing confounding by all of these variables. We then used logistic regression to compare placentophagic to non-placentophagic groups based on commonly-cited EPDS cutoff values (≥ 11; ≥ 13) for likely PPD.ResultsIn the unmatched and unadjusted analysis, placentophagy was associated with an increased risk of PPD. In the matched sample, 9.9% of women who ate their placentas reported EPDS ≥ 11, compared to 8.4% of women who did not (5.5% and 4.8%, respectively, EPDS ≥ 13 or greater). After controlling for over 90 variables (including prior mental health challenges) in the matched and adjusted analysis, placentophagy was associated with an increased risk of PPD between 15 and 20%, depending on the published EPDS cutoff point used. Numerous sensitivity analyses did not alter this general finding.ConclusionsPlacentophagic individuals in our study scored higher on an EPDS screening than carefully matched non-placentophagic controls. Why placentophagic women score higher on the EPDS remains unclear, but we suspect reverse causality plays an important role. Future research could assess psychosocial factors that may motivate some individuals to engage in placentophagy, and that may also indicate greater risk of PPD.

"Redefining Our Own Center”

Radical doulas are often on the frontlines supporting multiply marginalized birthing people. In providing emotional and physical support to people in labor, doulas are uniquely positioned to witness, to respond, to intervene in the obstetric racism and other forms of injustice unfolding in birth settings—an invariably rhetorical process. In this interview, we talk with Stevie Merino—medical anthropologist, full-spectrum doula, and the co-founder/executive director of the Birthworkers of Color Collective in Long Beach, California. Merino discusses how reproductive, racial, and queer justice informs her birthwork. This interview highlights the discursive and material strategies queer birthworkers of color deploy to support multiply marginalized clients, and the ways they navigate and challenge the existing medical system.

American Midwifery Certification Board Certification Demographic and Employment Data, 2016 to 2020: The Certified Nurse-Midwife and Certified Midwife Workforce.

Expansion and diversification of the midwifery workforce is a federal strategy to address the maternal health crisis in the United States. Understanding characteristics of the current midwifery workforce is essential to creating approaches to its development. Certified nurse-midwives and certified midwives (CNMs/CMs) certified by the American Midwifery Certification Board (AMCB) constitute the largest portion of the US midwifery workforce. This article aims to describe the current midwifery workforce based on data collected from all AMCB-certified midwives at the time of certification. Midwife initial certificants and recertificants were administered an electronic survey about personal and practice characteristics at the time of certification by AMCB between 2016 and 2020 for administrative purposes. Given the standard 5-year certification cycle, every midwife certified during this period completed the survey once. The AMCB Research Committee conducted a secondary data analysis of deidentified data to describe the CNM/CM workforce. In 2020 there were 12,997 CNMs/CMs in the United States. The workforce was largely White and female with an average age of 49. There has been a slow increase (15% to 21%) of initial certificants identifying as midwives of color. The proportion of CMs to all AMCB-certified midwives remained less than 2%. Physician-owned practices were the most common employer. Approximately 60% of midwives attend births, and hospitals were the most common birth setting. Over 10% of those certified to practice reported not working within the discipline of midwifery. Targeted recruitment and retention of midwives must take into consideration not just expansion but dispersion, scope of practice, and diversification. The proportion of midwives attending births was lower than reported in previous years. Expansion of the CM credential and accessible educational pathways are 2 potential solutions to workforce growth. Developing strategies to retain those who are trained but not practicing presents an opportunity for workforce maintenance.

Assessment of interprofessional obstetric and midwifery care from the midwives' perspective using the Interprofessional Collaboration Scale (ICS).

Interprofessional collaboration of physicians and midwives is essential for appropriate and safe care of pregnant and parturient women as well as their newborns. The complexity of woman-centered care settings requires the continuous exchange of information and the coordinated implementation of multi-and interprofessional care concepts. To analyze the midwives' perspective on the multi-and interprofessional care process during pregnancy, birth and postpartum period, we aimed to adapt and psychometrically evaluate the Interprofessional Collaboration Scale (ICS). The ICS (13 items) was answered by 299 midwives for (i) prenatal and postpartum care as well as (ii) perinatal care. Three items on equitable communication (EC) identified in qualitative interviews with N = 6 midwives were added as further aspects of quality in collaborative midwifery care. Confirmatory factor analysis was used to test competing theoretically hypothesized factorial model structures, including both care settings simultaneously, i.e., birth and prenatal/postpartum. A two-dimensional structure assuming the 13 original ICS items and the 3 items on EC as psychometric distinct item groups accounts for the data best. After deleting 5 ICS items with insufficient indicator reliability, a very good-fitting model structure was obtained for both prenatal/postpartum as well as perinatal care: χ2df = 192 = 226.35, p = 0.045, CFI = 0.991, RMSEA = 0.025 (90%CI: [0.004; 0.037]). Both the reduced ICS-R and the EC scale (standardized response mean = 0.579/1.401) indicate significantly higher interprofessional collaboration in the birth setting. Responsibility in consulting, attitudes toward obstetric care and frequency of collaboration with other professional groups proved to be associated with the ICS-R and EC scale as expected. For the adapted ICS-R and the EC scale a good construct validity could be confirmed. Thus, the scales can be recommended as a promising assessment for recording the collaboration of midwives with physicians working in obstetric care from the perspective of midwives. The instrument provides a validated assessment basis in midwifery and obstetric care to identify potentially divergent perspectives within interprofessional care teams in woman's centered care.

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

Background: Clubfoot is a birth defect found in about 1000 live births yearly in Cameroon and its treatment is often associated with relapses. The objective of this study was to evaluate treatment outcomes with the Ponseti’s technique and factors associated with relapses. Methods: We conducted a 5-year retrospective study on clubfoot children at the Bafoussam Baptist Healthcare Center (BBHC). Data on age, sex, birth setting, previous treatment, pirani scoring, number of casts and follow-ups, bracing and relapse were recorded in case report forms. Data were analyzed with SPSS: 25 software; bivariate analysis was performed to determine factors associated with relapse. Results: This study enrolled 78 clubfoot children with median age, 12 months (IQR1,24), 44 (56.4%) had undergone previous treatment elsewhere. The mean Pirani score before treatment was 4.9 [±SD: 0.9] for the left foot (LF), and 4.9 [±SD: 1] for the right (RF). The average number of casts performed was 6.5 [±SD: 1.5]. Tenotomy of the Achilles tendon was performed in 54 (69.2%) children. The mean final Pirani score was 0.9 [±SD: 0.5] for the LF and 0.8 [±SD: 0.6] for the RF. Only 5 (6.4%) cases did not wear Iowa braces and loss of sight rate was 1.3% (1/78). The relapse rate was 9.1% (7 /77). Treatment requiring &gt;8 casts was associated with relapse (aOR: 10.35; CI [1.05-101.55]; P=0.04). Conclusion: The Ponseti’s technique is effective in the treatment of CTEV in the West region of Cameroon. Treatment requiring more than 8 cats is a risk factor for relapse.

Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System.

Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.

Color, light, and birth space design: An integrative review

AbstractThis integrative review sought knowledge across a broad spectrum of literature concerning the role of color and light in maternity environments. Today it is acknowledged that the clinical nature of birth spaces is detrimental to maintaining normal physiological birth rates. Significantly, “clinical” spaces are often described as white, pale, monochromatic, and/or overlit. Attempts to make maternity settings more “home‐like” have promoted use of “warm” or “soft” colors. Ambience or spatial atmosphere is known to impact birth hormones, affecting labor commencement and progress. Today, efforts to improve birth spaces include “sensory rooms” (offering pain distraction via dark spaces and illuminated color elements); programmable colored light installations; and immersive image projections. Yet, as this paper shows, there is little specific study of the physical and psychological impact of color and light within birth settings. However, there are significant findings on colored light's impact upon birth processes, including the contraindication of bright blue light. And there is valuable knowledge embedded in old and new literature from diverse disciplines. This review thus exposes the strong need for further research and literature focused directly on how color and light in birth environment design impact birth experience for all involved. It is clear that environmental color and light need to be taken seriously as potent interrelated environmental factors that are directly implicated in the health and wellness of mothers and their infants during labor and birth. Thus, it is crucial to bring deeper awareness and comprehensive knowledge into use by designers, developers and managers of birth spaces.

Seeing Birth in a New Light: How Exposure to Homebirth Transforms Midwives’ Understanding of Physiological Birth

Since the 19th Century, hospital has been considered the default place of birth for Australian women, with the vast majority of women giving birth in hospital labour ward settings. Currently in Australia, less than 1,000 women give birth at home each year, with homebirths representing just 0.4% of all births in 2020.1 As such, many maternity-care providers have never been exposed to homebirth in their personal or professional lives, making them unfamiliar with this unique birth setting.

Maternal Health Understandings and Experiences of Bhutanese Refugee Women Pre- and Post-Settlement: A Qualitative Case Study

Refugee maternal health is an under-studied area in health science research since refugee women have complex health histories that consistently change throughout their resettlement journey. This study examined setting-based maternal health understanding among Bhutanese refugee women resettled in Greensboro, NC. We utilized qualitative case-study methods to examine n = 12 interviews within three different cases based on birth settings. Themes around women’s experiences of familial support, impact of setting-based maternal health access, and quality of care experienced were significant findings. Study aims were to help providers improve patient-provider interaction in relaying adequate care information and assess women’s pre-settlement health history for appropriate care.

Factors promoting or limiting self-determined childbirth: midwives’ perspectives in Germany

Abstract Background Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives’ experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation. Methods A qualitative case study was conducted based on semi-structured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis. Results The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person’s socioeconomic position; 6) Birthing person’s preparation/ education; 7) Birthing person’s capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives’ strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting. Conclusions The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments. Key messages • Self-determination (SD) in childbirth is influenced by several factors at individual, inter-personal, institutional and macro level. • Individual, institutional and political strategies may support SD.

Remembering Marian MacDorman.

Remembering Marian MacDorman.

Intersectional inequalities in loneliness among older adults before and during the early phase of the COVID-19 pandemic: A total population survey in the Swedish eldercare setting

Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.

Expectations of the upcoming birth – A survey of women’s self-efficacy and birth positions

BackgroundAdopting an upright sacrum flexible position may facilitate physiological childbirth, which many pregnant women wish for. A positive association between women’s choice on birthing position and birthing experience has been found. ObjectiveThe aim of this study was to examine women’s preferred birth position, self-efficacy at term and their actual birth position at time of birth. MethodsA survey of 554 pregnant Danish women at gestational week 38. Data was collected using an online survey and information was retracted from the woman’s medical record. Descriptive statistics and non-parametric tests were used and univariate and multivariate logistic regression models were used to analyse the association between self-efficacy and fulfilled wish of birth position. FindingsThe majority of women (>70 %) wished to give birth in a sacrum flexible position but more than 80 % gave birth in a non-flexible position. Less than 50 % had their wish of birth position fulfilled. All women reported overall high self-efficacy. No difference in having wish for birth position fulfilled was found comparing women with high and low self-efficacy. ConclusionsMost women wished for a sacrum flexible position but more than 80% gave birth in a sacrum non-flexible position and less than 50% had their wish for birth position fulfilled. Level of self-efficacy did not affect the likelihood of having wish of birth position fulfilled indicating that the culture at the birth setting and skills and attitudes among birth providers may have a considerable impact on women’s choice of birth position.

Improving Our Maternity Care Now Through Community Birth Settings.

This contribution reprints the Executive Summary from a technical report issued by the National Partnership for Women & Families within its larger Improving Our Maternity Care Now project. This project identifies the priority of continuing the long, challenging work of maternity care system transformation, while also increasing access to high-performing care models that can help meet current urgent, dire needs for equitable high-quality care now. The Community Birth Settings report (encompassing birth center and planned home birth care) is the second in a series of four reports on these care models, which share distinctive features. They reliably provide highly appropriate services that minimize both underuse of beneficial practices and overuse of unneeded, often harmful practices. They prioritize relationship-based, whole person care that builds trust, confidence and resilience and helps meet the varied needs of birthing families. They incorporate skills and knowledge to support the innate physiologic processes of birthing people and their fetuses/newborns. They achieve remarkable results for consequential outcomes relative to standard maternity care. And childbearing people greatly desire access to these forms of care relative to current access and use. Community-based versions offering trustworthy, respectful, culturally-congruent care are especially powerful. The community birth settings report includes recommendations for federal policymakers, state policymakers, and private sector decision makers to increase access to these settings. It was carried out in partnership with the American Association of Birth Centers, American College of Nurse-Midwives, Birth Center Equity, National Association of Certified Professional Midwives, and National Black Midwives Alliance. Access the full project through https://www.nationalpartnership.org/improvingmaternitycare/. The project is supported by the Yellow Chair Foundation. Reproduced with permission of the National Partnership for Women & Families.

P32 - An Interprofessional approach to clinical facilitation of midwifery and medical students in the Birth Suite

Quality clinical placement experiences are vital to prepare undergraduate students for their future professional role. Traditionally clinical placements are facilitated in professional silos, a model that when reviewed in the birth suite of a large regional hospital in Victoria, revealed a highly competitive culture of midwifery and medical students who often struggled to meet learning objectives. To address this, an Interprofessional Clinical Facilitator (IPCF) model was introduced that was underpinned by interprofessional education theory and collaborative practice. Facilitators actively supported students to immerse themselves in interprofessional learning experiences in the birth suite, whilst learning how, as a team, they could best support women in the labour and birth setting. The aim of this research was to evaluate the ICPF model in the birth suite. Between 2017 and 2021 midwifery and medical students on clinical placement in birth suite at a large regional Victorian hospital were invited to evaluate their placement by completing an anonymous online survey consisting of statements about placement experience with a 7-point Likert scale and open-ended questions. Ethics approval was obtained. Quantitative data was collected utilising routinely collected data from the Birthing Outcome System to identify student presence and clinical activity in the birthing environment. Results of the student’s evaluation of their placement experiences following implementation of the interprofessional clinical facilitation model will be presented with students describing a more supportive and collaborative learning environment. Data demonstrating learning requirements are being met and an increase in students accoucheuring births despite a decrease in vaginal birth numbers will also be presented. The success of the interprofessional facilitation placement model in Birth Suite has resulted in a significant improvement to the quality of the student learning environment. These outcomes support consideration of wider adoption of this model in other clinical teaching settings.

O6 - “A way to bring my labour back to normal”: An immersive sensory experience during childbirth

The setting in which a woman labours, influences her birth experience. Ninety-seven percent of women in Australia give birth in conventional hospital birth suites, where medical safety often overshadows attention to psychological needs. Sensory information from the external environment can help decrease pain, fear, and stress through oxytocin-mediated neurohormonal processes. No place is this more urgently needed than in the hospital birth suite. This proof-of-concept study aimed to explore women’s and midwives' experiences of using an immersive sensory experience (ISE) during labour. We installed a screen projecting nature-themed films and conducted a thematic analysis of interviews with 32 women who laboured in this setting. All the women received continuity of midwifery care from caseload midwives. Four in five women had medical or obstetric risk factors, and two-thirds had their labour induced. Semi-structured interviews were conducted with nine midwives who worked in caseload and had cared for women who used the ISE. Three themes emerged from interviews with women: 1) Serenity and calm; 2) Redirection of attention; and 3) Immersive feeling. Three themes emerged from interviews with midwives: 1) The ISE aligned with midwives’ identity and birthing philosophies; 2) The ISE inspired care practices that supported physiology; and 3) The ISE improved midwives’ experience of providing care. The findings are consistent with research demonstrating the effects of physical attributes of the environment on caregiver behaviour and women’s experiences. Overwhelmingly these finding demonstrate that midwives, women, and their partners enjoyed the immersive experience and how it positively improved the birth setting to optimise physiological labour and birth. No safety concerns were identified, and midwives reported positive feedback from colleagues.

Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic.

The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic. An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making. Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P &lt; .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P &lt; .001), and salary (19.7% vs 7.0%; P &lt; .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes. Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.

Maternity service reconfigurations for intrapartum and postnatal midwifery staffing shortages: modelling of low-risk births in England

IntroductionChoice of birth setting is important and it is valuable to know how reconfiguring available settings may affect midwifery staffing needs. COVID-19-related health system pressures have meant restriction of community...