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Toll K, Sharp T, Reynolds K, Bradfield Z. Advanced midwifery practice: A scoping review. Women Birth 2024; 37:106-117. [PMID: 37845089 DOI: 10.1016/j.wombi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
PROBLEM There is no international standard for advanced midwifery scope of practice. BACKGROUND Globally, there is variance in how scope of midwifery practice is determined and regulated, with no consensus on extended or advanced scope. This can lead to under-utilised staff potential, un-met consumer need, and loss of professional skill. AIMS The aim of this scoping review was to synthesise and map what is reported in the international literature on the advanced scope of midwifery practice. METHODS A systematic scoping review methodology was adopted utilising Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A full search was conducted of databases including MEDLINE, CINAHL, Scopus, Google. Publications from 2019 to August 2022 that met criteria were included. Reported skills were mapped to the International Confederation of Midwives (ICM) competencies of pre-conception, antenatal, labour and birth, postnatal plus globally identified areas for midwifery investment. FINDINGS 28 articles met inclusion criteria. Reported skills included abortion care (n = 6), prescribing (n = 7), ultrasound (n = 2), advanced practice skills (n = 7), midwifery-led skills, primary health, post-graduate education, HIV/AIDS testing, advocacy, and acupressure (all n = 1). DISCUSSION This review presents a synopsis of publications describing what has been defined as advanced midwifery scope of practice in international contexts. CONCLUSION Establishing evidence of midwives working to the peak of professional scope is important to continue to develop professional capacity and support contemporary practice, regulation, governance, and policy while improving consumer access to equitable care. Findings aid service development, provision, and professional planning.
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Affiliation(s)
- Kaylie Toll
- School of Population Health, Curtin University, Perth, Western Australia, Australia.
| | - Tarryn Sharp
- WA Country Health Service, Western Australia, Australia
| | - Kate Reynolds
- WA Country Health Service, Western Australia, Australia
| | - Zoe Bradfield
- School of Nursing, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
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Nethery E, Schummers L, Levine A, Caughey AB, Souter V, Gordon W. Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State. Obstet Gynecol 2021; 138:693-702. [PMID: 34619716 PMCID: PMC8522628 DOI: 10.1097/aog.0000000000004578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe rates of maternal and perinatal birth outcomes for community births and to compare outcomes by planned place of birth (home vs state-licensed, freestanding birth center) in a Washington State birth cohort, where midwifery practice and integration mirrors international settings. METHODS We conducted a retrospective cohort study including all births attended by members of a statewide midwifery professional association that were within professional association guidelines and met eligibility criteria for planned birth center birth (term gestation, singleton, vertex fetus with no known fluid abnormalities at term, no prior cesarean birth, no hypertensive disorders, no prepregnancy diabetes), from January 1, 2015 through June 30, 2020. Outcome rates were calculated for all planned community births in the cohort. Estimated relative risks were calculated comparing delivery and perinatal outcomes for planned births at home to state-licensed birth centers, adjusted for parity and other confounders. RESULTS The study population included 10,609 births: 40.9% planned home and 59.1% planned birth center births. Intrapartum transfers to hospital were more frequent among nulliparous individuals (30.5%; 95% CI 29.2-31.9) than multiparous individuals (4.2%; 95% CI 3.6-4.6). The cesarean delivery rate was 11.4% (95% CI 10.2-12.3) in nulliparous individuals and 0.87% (95% CI 0.7-1.1) in multiparous individuals. The perinatal mortality rate after the onset of labor (intrapartum and neonatal deaths through 7 days) was 0.57 (95% CI 0.19-1.04) per 1,000 births. Rates for other adverse outcomes were also low. Compared with planned birth center births, planned home births had similar risks in crude and adjusted analyses. CONCLUSION Rates of adverse outcomes for this cohort in a U.S. state with well-established and integrated community midwifery were low overall. Birth outcomes were similar for births planned at home or at a state-licensed, freestanding birth center.
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Affiliation(s)
- Elizabeth Nethery
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Laura Schummers
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Audrey Levine
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Aaron B. Caughey
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Vivienne Souter
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
| | - Wendy Gordon
- School of Population and Public Health and the Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada; Smooth Transitions, Foundation for Health Care Quality, Seattle, Washington; the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Obstetrical Care Outcomes Assessment Program, the Department of Health Services, School of Public Health, University of Washington, and the Department of Midwifery, Bastyr University, Seattle, Washington
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Effland KJ, Hays K, Zell BA, Lawal TK, Grantham RL, Koontz M. Increasing Access to Medications and Devices for the Care of Low-Risk Childbearing Families: An Analysis of Existing Law and Strategies for Advocacy. J Midwifery Womens Health 2021; 66:604-623. [PMID: 34437753 DOI: 10.1111/jmwh.13275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
Limited access to medications and devices relevant to the care of low-risk childbearing families acts as a barrier to the successful integration of high-quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community-based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state-licensed midwives. These professionals are the primary health care providers offering community-based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community-based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence-based care. Policy makers can improve health, health equity, consumer choice, and access to evidence-based care by using ideal legal language for midwifery practice authority.
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Affiliation(s)
- Kristin J Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington.,Midwives College of Utah, Salt Lake City, Utah
| | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington
| | - Britney A Zell
- Department of Midwifery, Bastyr University, Kenmore, Washington
| | | | | | - Megan Koontz
- Midwives College of Utah, Salt Lake City, Utah.,National Association of Certified Professional Midwives, Keene, New Hampshire
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