Labial lacerations or skin splits that did not require suturing occurred in 12.8% of the women, and 4.8% had more substantial labial lacerations that required suturing. The authors have no conflicts of interest to disclose. Prospective cohort studies with matched comparison groups that utilize the large datasets collected by MANA Stats and AABC's UDS have the potential to address critical gaps in our understanding of birth settings and providers in the United States. The second method is technically correct. Introduction: Data on the safety of waterbirth in the United States are lacking. DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL BAKIŞ; RİSKLER VE FAYDALARI. All measures of maternal morbidity were lower in the planned home birth group, as were rates for all obstetric interventions including cesarean (5.2% vs 8.1%; RR 0.64; 95% CI, 0.56‐0.73). Data were analyzed according to intended and actual place of birth. This dataset is intended to support research on midwifery practice and normal birth with the goal of improving care of women and babies and increasing the choices available to childbearing families. Joseph R. Wax, Michael G. Pinette, Outcomes of Care for 16,925 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009, Journal of Midwifery & Women's Health, 10.1111/jmwh.12209, 59, 3, (366-366), (2014). Utility of the 5-Minute Apgar Score as a Research Endpoint. Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. The final sample included 16,924 women and 16,984 newborns (Figure 1). Saraswathi Vedam, CNM, RM, MSN, FACNM, SciD(hc), is an Associate Professor in the Faculty of Medicine at the University of British Columbia. Despite attempts to design a randomized controlled trial, sufficient numbers of women have not consented to be randomized according to birth site.9. The Midwives Alliance of North America is a Montvale-based company founded in 1982. Swimming against the tide: Women's experience of choosing a homebirth in Switzerland. Interdecadal variation of biases in a regional climate model simulation of summer climate of East Asia. Abbreviations: CI, confidence interval; NICU, neonatal intensive care unit. J Midwifery Womens Health. Of the 16,924 women who began labor at home, 89.1% completed a home birth for an intrapartum transfer rate of 10.9%. In 1982, The Midwives Alliance of North America (MANA) was established as a professional organization for midwives.Its stated goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities. Working off-campus? Black midwifery in the United States: Past, present, and future. Thus, our final sample for this analysis consisted of all planned home births (N = 16,924). In mid-2011 the current data form was launched, also developed using the CBPR model. Obstetric practices in planned home births assisted in Brazil. This National Birth Center Study II reported excellent outcomes and reduced interventions as a result of midwifery‐led care in birth centers. On January 30, 2014, a major study was published in the Journal of Midwifery and Women's Health analyzing birth data collected through MANA Stats, entitled "Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009." The Midwives' Alliance of North America (MANA) was founded in April 1982, to build cooperation among midwives and to promote midwifery as a means of improving health care for women and their families. Its stated goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities. Journal of Midwifery & Women’s Health, Volume … Abbreviations: MANA, Midwives Alliance of North America; NICU, neonatal intensive care unit; TOLAC, trial of labor after cesarean. A complete understanding of the safety of planned home and birth center birth is difficult to achieve. Delimitation begins with all records entered into the Midwives Alliance of North America Statistics Project (MANA Stats) using the 2.0 data form (birth years 2004‐ 2009). She is also the Director of Research Education for the MANA Division of Research and faculty at the Midwives College of Utah. Women's experiences with giving birth before arrival. Fewer than 1% of newborns were low birth weight (<2500 g), although almost one‐quarter were macrosomic (> 4000 g) (Table 3). Data were collected between 2004 and 2009 using the MANA Stats 2.0 Web‐based data collection tool, which was developed by the MANA Division of Research in 2004 in accordance with the Agency for Healthcare Research and Quality guidelines.19 Participation in the project was voluntary, with an estimated 20% to 30% of active CPMs and a substantially lower proportion of CNMs contributing.5 Midwife participants obtained written informed consent from all clients at the onset of care, and only data from women who consented were included in the research dataset. MANA #RISE2020 is an online conference produced by the Midwives Alliance of the North America on the GOLD Learning platform. Midwifery education in the U.S. - Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife. Since 1982, MANA has been bringing together midwives from all types of backgrounds to create strength and solidarity among midwives in North America. In this sample, primiparous women were at increased risk of having an intrapartum fetal death compared to multiparous women (2.92/1000 primiparous vs 0.84/1000 multiparous, P < 0.01). Nationwide, midwives or midwifery practices from 43 states actively participate. Use the link below to share a full-text version of this article with your friends and colleagues. The analogy to a lifeguard is particularly apt since midwives are hired for the express purpose of keeping baby and mother safe. Learn more. Utilizing Datasets to Advance Perinatal Research. Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States. Between 2004 and 2010, the number of home births in the United States rose by 41%, increasing the need for accurate assessment of the safety of planned home birth. Web site and data forms ©2004-2020 Midwives Alliance In 2009, 3 well‐designed, population‐based cohort studies were published comparing planned home births to planned hospital births with professional midwives as attendants. The number of unknown causes of death in our sample is also at least partially attributable to parents declining autopsies49; of the 35 intrapartum and neonatal deaths not attributed to congenital anomaly, only 6 received an autopsy. Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. We interpret these findings in 2 ways. In addition, the data entered into the MANA Stats system come from medical records. Professional perspectives on planned home births. 2014 May-Jun;59(3):366. About the project. The role of Cor‐Knot in the future of cardiac surgery: A systematic review. A prognostic model composed of four long noncoding RNAs predicts the overall survival of Asian patients with hepatocellular carcinoma. Trabecular bone deterioration in differentiated thyroid cancer: Impact of long‐term TSH suppressive therapy. Postpartum maternal transfer occurred for 1.5% of women who went into labor intending to give birth at home and occurred for 1.7% of women who gave birth at home. Of note, greater than 6% of the sample was identified by their midwife as Amish or Mennonite. This study examines outcomes of planned home births in the United States between 2004 and 2009. 2) What are the characteristics of midwife‐led care that contribute to safe physiologic birth? There are 2 exceptions: neonatal transfers and postpartum transfers are reported among the entire sample of neonates/women, as well as among only those who gave birth at home, thus excluding intrapartum transfers. Of the 1856 women who transferred to the hospital during labor, more than half gave birth vaginally (Table 4). Pregnancy, Birth and the COVID-19 Pandemic in the United States. For all newborns in the sample (including those with congenital anomalies and regardless of actual location of birth), 1.5% (n = 245) had 5‐minute Apgar scores below 7, and 0.6% (n = 97) had Apgar scores below 4. Home birth: What are physicians’ ethical obligations when patient choices may carry increased risk? Our main analyses, in keeping with the descriptive objective of this study, consisted of calculating basic frequencies, measures of central tendency, measures of variance, and confidence intervals as indicated. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009 J Midwifery Womens Health. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The Use of Tranexamic Acid to Prevent Postpartum Hemorrhage. Please check your email for instructions on resetting your password. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. You can find similar websites and websites using the same design template.. Mana.org has an estimated worth of 3,393 USD. The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study. No significant differences were found between the home birth group and either comparison group with respect to the diagnosis of asphyxia at birth, seizures, need for assisted ventilation beyond the first 24 hours of life, or low 5‐minute Apgar scores (< 7). For the 7 newborns who died during the early neonatal period, 2 were secondary to cord accidents during birth (one with shoulder dystocia), and the remaining 5 were attributed to hypoxia or ischemia of unknown origin. These findings are consistent with outcomes reported in the National Birth Center Study II.14. Delimitation begins with all records entered into the Midwives Alliance of North America Statistics Project (MANA Stats) using the 2.0 data form (birth years 2004‐ 2009). Cheyney, M et al, 30 January 2014. Breast cancer survivors' risk of interval cancers and false positive results in organized mammography screening. Reply to Farr et al. Darcy Hannibal, PhD, is a primatologist conducting research on welfare improvement for the Behavioral Management Program at the California National Primate Research Center at the University of California (UC) Davis. Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands. Low‐risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes. The second study, a prospective, 5‐year (2000‐2004) matched cohort study in British Columbia, compared outcomes for low‐risk women in a midwife‐attended planned home birth group (n = 2889), a physician‐attended hospital birth group (n = 5331), and a midwife‐attended planned hospital birth group (n = 4752).11 In this intention‐to‐treat analysis, women in the planned home birth group had significantly fewer intrapartum interventions, including narcotic or epidural analgesia, augmentation or induction of labor, and assisted vaginal or caesarean birth—as well as significantly fewer adverse outcomes, including postpartum hemorrhage, and third‐ or fourth‐degree lacerations. Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home. Almost two‐thirds of the women in this sample paid for midwifery care out‐of‐pocket, either because their insurance did not cover home birth, their midwife did not provide insurance billing, or because they were uninsured. We would also like to acknowledge Peggy Garland for early leadership on the MANA Division of Research and Geradine Simkins for her longstanding support of this project. The spontaneous vaginal birth rate for the sample was 93.6%. METHODS: We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out‐of‐Hospital Birth Settings: A Retrospective Case Series. Midwives Alliance midwives have been collecting their statistics for research purposes for many years. In the first study, de Jonge and colleagues10 used a national dataset (N = 529,688) of low‐risk pregnancies in the Netherlands to compare perinatal mortality and morbidity outcomes for planned home (60.7%) and hospital births (30.8%) between 2000 and 2006. No differences were found between groups for perinatal and neonatal composite outcome measures (2.4% vs 2.8%; relative risk [RR] 0.84; 95% confidence interval [CI], 0.68‐1.03). She is also a board member and Director of Equity Initiatives for the Association of Midwifery Educators. Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes, http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html, http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/index.html, Region 1: New England (CT, MA, ME, NH, RI, VT), Region 2: North Atlantic (DC, DE, NJ, NY, MD, PA), Region 3: Southeast (AL, AR, FL, GA, LA, MS, NC, KY, SC, TN, VA, WV), Region 4: Midwest (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI), Region 5: West (AZ, CO, ID, MT, NM, NV, OK, TX, UT, WY), Self‐pay (does not necessarily mean uninsured), Government insurance (includes Medicaid, CHAMPUS), Assisted vaginal (166 vacuum, 35 forceps). For more information on Midwives: American College of Nurse-Midwives; Citizens for Midwifery ; Footnotes: 1. The most common reason for transfer was failure to progress (n = 752, 40.7% of intrapartum transfers). In This Issue—Making Home Birth Even Safer for Mothers and Babies. The MANA Stats 2.0 online form collected data on nearly 200 variables, including demographic characteristics of participating women and families; pregnancy history as well as general health and social histories; antepartum, intrapartum, neonatal, and postpartum events and procedures; and maternal and newborn outcomes. Benchmarking: Benchmarking means the reporting of basic statistics for key items in a dataset. However, because the MANA Stats system requires that clients be logged early in prenatal care, any such exclusions would have occurred prior to the outcome of the birth being known.5. The intrapartum fetal death rate among women planning a home birth in our sample was 1.3 per 1000 (95% CI, 0.75‐1.84). The rate of vacuum or forceps‐assisted vaginal birth was 1.2%. Differentiating Research, Quality Improvement, and Case Studies to Ethically Incorporate Pregnant Women. Collectively, our findings are consistent with the body of literature that shows that for healthy, low‐risk women, a planned home birth attended by a midwife can result in positive outcomes and benefits for both mother and newborn. She is also a certified professional midwife, licensed in the State of Oregon, and the Chair of the Division of Research for the Midwives Alliance of North America (MANA). At pains to consent: A narrative inquiry into women's attempts of natural childbirth. Low‐risk women in this sample experienced high rates of normal physiologic birth and very low rates of operative birth and interventions, with no concomitant increase in adverse events. Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births. The Midwives Alliance of North America (MANA) was founded in April 1982 to build cooperation among midwives and to promote midwifery as a means of improving health care for North American women and their families. Of the parous women, 8.0% had a history of previous cesarean. Data were contributed by 432 different midwives, including CPMs/LMs/LDMs, CNMs/CMs, naturopathic midwives, unlicensed direct‐entry midwives, and others (Table 1). Effectiveness of an oral health education programme for older adults using a workbook. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively. Neonatal transfer occurred for 0.9% (149/16,984) of all newborns whose mothers went into labor intending to give birth at home and occurred for 1.0% (149/15,134) of the newborns born at home. Web site and data forms ©2004-2020 Midwives Alliance Understanding Recent Home-Birth Research: An Interview With Drs. Midwives Alliance of North America / MANA. and you may need to create a new Wiley Online Library account. There was no evidence of increased risk of death among multiple births. Although midwives in all states are eligible to contribute data to MANA Stats, the 2.0 home birth cohort comes disproportionately from the Western United States. Introduction: Data on the safety of waterbirth in the United States are lacking. Of the women who lost greater than 500 mL of blood after a vaginal birth, 51.4% were given oxytocin (n = 797), methergine (n = 132), or both (n = 317) to control bleeding. MANA Statistics Project (MANA Stats) is a research registry of birth information operated by the Midwives Alliance of North America since 2004. This study examines outcomes of planned home births in the United States between 2004 and 2009. Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth, Part 1. Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 METHODS: We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Mother–newborn dyads transferred during the intrapartum period are not at risk of postpartum or neonatal transfer. Home Birth Midwifery in the United States. Application of the Principles of Biomedical Ethics to the Labor and Delivery Unit During the COVID-19 Pandemic. Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth, Part 2. During the first 6 weeks postpartum, 479 (2.8%) newborns were admitted to the NICU (Tables 3 and 4). Abbreviations: CM, certified midwife; CNM, certified nurse‐midwife; CPM, certified professional midwife; LDM, licensed direct‐entry midwife; LM, licensed midwife. At present approximately 123 California midwives voluntarily participate in MANA Stats. Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. Number of times cited according to CrossRef: The COVID-19 Pandemic as a Catalyst for More Integrated Maternity Care. Intrapartum and neonatal mortality in low‐risk term women in midwife‐led care and obstetrician‐led care at the onset of labor: A national matched cohort study. She is also Laboratory Manager for the McCowan Animal Behavior Laboratory for Welfare and Conservation in the Department of Population Health and Reproduction at UC Davis. 476: Planned home birth, Homebirth transfers in the United States: Narratives of risk, fear, and mutual accommodation, Registries for Evaluating Patient Outcomes: A User's Guide, The Security Rule. Final analyses are limited to women who planned home birth at onset of labor (N = 16,924). The MANA Statistics Project has been generously funded by the Foundation for the Advancement of Midwifery, the Transforming Birth Fund, and the MANA Board of Directors. Planned home birth was associated with significantly fewer interventions, higher maternal satisfaction, and increased cost‐effectiveness compared to birth in a hospital obstetric unit.13 Most recently, Stapleton and colleagues14 described outcomes from births attended by certified nurse‐midwives (CNMs), licensed midwives (LMs), and CPMs that occurred in birth centers in the United States. 5. Midwives Alliance of North America, or MANA, has recently released data on over 16,000 home birth outcomes. Midwives Alliance of North America Last updated April 24, 2019. Of the 16,039 women who gave birth vaginally, 49.2% did so over an intact perineum; 1.4% had an episiotomy; 40.9% sustained a first‐ or second‐degree perineal laceration; and 1.2% had a third‐ or fourth‐degree perineal laceration. In addition, of the 50 women with multiple gestations who had complete data on visits with other providers, 22 saw an obstetrician prenatally at least once, and 13 saw an obstetrician at least 3 times. Antenatal risk profiles of the women are presented in Table 2. Midwives Alliance midwives contributed data to a significant study of planned homebirths, "Outcomes of planned home births with certified professional midwives: large prospective study in North America," published June 18, 2005 in the British Medical Journal. Marit Bovbjerg, PhD, MS, is a Research Associate (postdoctoral) in the College of Public Health and Human Sciences at Oregon State University in Corvallis, Oregon. The remaining postpartum transfers were for a variety of reasons including abnormal maternal vital signs, hematoma, unassisted precipitous labor when parents called emergency medical services, or mother unable to void. When lethal congenital anomaly‐related deaths were excluded (n = 0 intrapartum, n = 8 early neonatal, n = 1 late neonatal), the rates of intrapartum death, early neonatal death, and late neonatal death were 1.30 per 1000 (n = 22), 0.41 per 1000 (n = 7), and 0.35 per 1000 (n = 6), respectively (Table 5). Community Versus Out‐of‐Hospital Birth: What's in a Name?. Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey. For instance, the denominator for low Apgar score (< 7) is liveborn newborns. Midwives Alliance of North America 611 Pennsylvania Avenue SE # 1700 Washington, DC 20003-4303 Dear Ms. Simkins: Your public claim that "doctors ignore evidence" on homebirth safety is shocking (President’s Editorial, July 11, 2008). All data from the 2.0 dataset were exported from the structured query language‐based online data collection system as a comma‐separated value (*.csv) file and then imported into SPSS Statistics24 for analysis. Midwives in the United States provide assistance to childbearing women during pregnancy, labor and birth, and the postpartum period.Some midwives also provide primary care for women including well woman exams, health promotion and disease prevention, family planning options, and care for common gynecological concerns. Homebirth Transfers in the United States. The rate of early neonatal death (death occurring after a live birth, but before 7 completed days of life) was 0.88 per 1000; and the rate of late neonatal death (death occurring at 7 to 27 completed days of life) was 0.41 per 1000. The data collection design for MANA Stats includes preregistration, or prospective logging, of all clients at the start of care, before outcomes are known. The complete November 2004 through December 2009 MANA Stats 2.0 dataset (N = 24,848) includes records from all women receiving at least some prenatal care from contributor midwives. Departures in Critical Qualitative Research. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital. Data were also collected on antepartum, intrapartum, and postpartum maternal and neonatal transfers, as well as on intended and actual place of birth. Abbreviations: BMI, body mass index; CHAMPUS, Civilian Health and Medical Program of the Uniformed Services; IQR, interquartile range; MANA, Midwives Alliance of North America; SD, standard deviation. Data were analyzed according to intended and actual place of birth. Data on outcomes from planned home births in the United States have not been reported in the peer‐reviewed literature since 2005,4 when Johnson and Daviss described outcomes for 5418 home births attended by CPMs in 2000. Of the 127 breech neonates born vaginally, 92% were born at home. Summary: This is the largest study to-date on outcomes of planned, midwife-attended homebirths in the United States Given the low absolute number of events and the lack of a matched comparison group, we were unable to discern whether poorer outcomes among higher‐risk women were associated with place of birth or related to risks inherent to their conditions. The causes of the remaining 9 intrapartum deaths were unknown. J Midwifery Womens Health. Of the 22 fetuses who died after the onset of labor but prior to birth, 2 were attributed to intrauterine infections, 2 were attributed to placental abruption, 3 were attributed to cord accidents, 2 were attributed to complications from maternal GDM, one was attributed to meconium aspiration, one was attributed secondary to shoulder dystocia, one was attributed to preeclampsia‐related complications, and one was attributed to autopsy‐confirmed liver rupture and hypoxia. Multistate Collaboration to Confidentially Review Unanticipated Perinatal Outcomes. Complete demographic characteristics for the sample are reported in Table 2. Prevalence of Home Births and Associated Risk Profile and Maternal Characteristics, 2016–2018. Journal of Midwifery & Women’s Health, 59(1): 17-27. There were several incidences when the midwife or receiving physician suspected congenital defect based on visual assessment, but an autopsy or other testing was declined and no official cause of death was assigned. A total of 222 newborns in a breech presentation were born vaginally (57.2%) or by cesarean (42.8%) (Table 3). Ninety‐two percent of newborns were full‐term, 2.5% were preterm, and 5.1% were postterm based on the midwife's clinical gestational age assessment following birth. This study examines outcomes of planned home births in the United States between 2004 and 2009. Acta Obstetricia et Gynecologica Scandinavica. Clinical response to chemoradiotherapy in esophageal carcinoma is associated with survival and benefit of consolidation chemotherapy. In this large national sample of midwife‐led, planned home births in the United States, the majority of women and newborns experienced excellent outcomes and very low rates of intervention relative to other national datasets of US women.27-29 Rates of spontaneous vaginal birth, cesarean, low 5‐minute Apgar score (<7), intact perineum, breastfeeding, and intrapartum and early neonatal mortality are all consistent with reported outcomes from the best available population‐based observational studies of planned home and birth center births.2, 10-12, 14, 30 Rates of successful VBAC are higher than reported elsewhere (87% vs 60‐80%),31-33 with no significant increase in early or overall neonatal mortality. The majority of births in the sample were attended by CPMs (79.2%). Midwives Alliance midwives have been collecting their statistics for research purposes for many years. Midwifery Provision of Home Birth Services. In addition, the frequency of postpartum maternal transfer for excessive bleeding was low overall, suggesting that midwife contributors to MANA Stats did not deem all cases of blood loss greater than 500 mL to require pharmacologic intervention or transfer. American College of Nurse-Midwives. Birthplace in Australia: Antenatal preparation for the possibility of transfer from planned home birth. The majority of these 149 newborn transfers were for respiratory distress and/or Apgar scores below 7 (n = 116, 77.9%); an additional 9 newborns (6.0%) were transferred for evaluation of congenital anomalies. For example, the 2.0 dataset contains all of the pregnancy, labor, birth, and newborn information recorded in the 24,000+ charts that midwives then entered into the MANA Stats database from 2004 to 2009. However, because the reporting of these variables is not consistent in the literature,14, 25 we report both values to allow for comparison with as many other studies as possible. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. The Pre-recorded pre-conference Workshop by Breech Without Borders is a two-day offering that is eligible for 12 CEUs and that will be available throughout the month of October with additional availability through November for those who also register for the live … Methods: We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. It appeared in the same issue of the Journal of Midwifery and Women's Health. Nationwide, midwives or midwifery practices from 43 states actively participate. Nature and scope of certified nurse‐midwifery practice: A workforce study. Midwives Alliance of North America / MANA. Low Apgar scores (< 7) occurred in 1.5% of newborns. Development and Validation of a National Data Registry for Midwife‐Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset. More than 95% of women consented to be included,5 a high rate of participation that has been observed in other studies involving this population.4, 14 All analyses presented here were approved by the institutional review board at Oregon State University. In early 2009, the site launched a new data form developed using a Community Based Participatory Research model. Officers were chosen and a newsletter Practicing Midwife (changed to MANA News in 1983) was established. Midwives on the Margins: Stigma Management among Out-of-Hospital Midwives. Because medical records are kept primarily for patient care purposes with secondary uses for billing, research, and legal documentation, researchers using data derived from medical records must be cognizant of these limitations.50-53 However, we expect that the outcomes reported here were likely to be recorded in the medical record with a reasonably high degree of accuracy because of their importance to clinical care. Planned home births: the need for additional contraindications. Addition of your name to the midwife referral list. Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. Courtney Everson, MA, is a Doctoral Candidate in medical anthropology in the Department of Anthropology at Oregon State University in Corvallis, Oregon. In each case, the midwife had a duty to aid the mother and baby. The MANA Statistics Project web site was created by Harris-Braun Enterprises and Bruce Ackerman. Data were analyzed according to … Twenty‐two percent of the sample was nulliparous, and 9.2% of multiparous women were grand multiparas (≥ 5 previous births after 20 weeks’ gestation). Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. A Certified Professional Midwife (CPM) ® is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. Newborns born to primiparas were not, however, at increased risk of either early or late neonatal death. For this large cohort of women who planned midwife‐led home births in the United States, outcomes are congruent with the best available data from population‐based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. The sample mean (SD) for live birth weight was 3651 g (488 g). Further Applications of Advanced Methods to Infer Causes in the Study of Physiologic Childbirth. These data were collected through the Uniform Data Set (UDS), a Web‐based tool developed by the American Association of Birth Centers (AABC) for use in member centers. For most perinatal outcomes, the denominator is newborns—removing those no longer at risk. The lack of power is further compounded in studies of planned home and birth center births because cohorts from these birth locations are commonly comprised of relatively low‐risk women, thus fewer deaths are expected. The main limitation of this study is that the sample is not population‐based. This multiparous mother had no antenatal or intrapartum risk factors. Development and validation of a national data registry for midwife-led births: The midwives alliance of North America statistics project 2.0 dataset Melissa Cheyney, Marit Bovbjerg, Courtney Everson, Wendy Gordon, Darcy Hannibal , Saraswathi Vedam What Is A CPM. Midwife contributors complete the Web‐based form over the course of care through the 6‐week postpartum visit, or the final visit if earlier. Jan-Feb 2014;59(1):17-27. doi: 10.1111/jmwh.12172. Of women who gave birth vaginally, 15.5% (n = 2426) lost greater than 500 mL of blood following birth, and 4.8% (n = 318) lost 1000 mL or greater. Most women began their pregnancies with a normal (18.5‐25 kg/m2) body mass index (BMI). We are also grateful for the midwives and families who have contributed their time and data to the project over the last 9 years and to those who have contributed as dedicated volunteers. In addition, in keeping with standards for reporting results from observational studies,26 we have included the actual denominators (ie, the theoretical denominator of women, or liveborn newborns, minus participants missing data for that variable) as well as 95% CIs, as relevant. When higher‐risk women (those with multiple gestations, breech presentation, TOLAC, GDM, or preeclampsia) were removed from the sample, the intrapartum death rate was 0.85 per 1000 (95% CI, 0.39‐1.31). Very few of the pregnancies in our sample were complicated by maternal comorbidities, including hypertensive disorders, gestational diabetes mellitus (GDM), persistent anemia (defined as hematocrit <30 or hemoglobin <10 g/dL), or Rh sensitization. The rate of intrapartum fetal death (occurring after the onset of labor, but prior to birth) was 1.30 per 1000. The overall cesarean rate was 5.2%, and most of these were primary cesareans (84.4%). Descriptive data from the first 6 years (2004‐2009) of the MANA Statistics Project demonstrate that for this large, national cohort of women who planned home births under the care of a midwife, perinatal outcomes are congruent with the best available data from population‐based observational studies that have evaluated outcomes by intended place of birth and by pregnancy risk profiles. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants. Risk of severe postpartum hemorrhage in low‐risk childbearing women in New Zealand: Exploring the effect of place of birth and comparing third stage management of labor, Postpartum hemorrhage: Update on problems of definitions and diagnosis, Measurement of blood loss: Review of the literature. Only 0.4% (n = 70) were never breastfed, and 86.0% (n = 14,344) were exclusively breastfed through at least 6 weeks postpartum. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. The newborn was born vaginally at home with Apgar scores of 8 and 9 at 5 and 10 minutes, respectively, and the postpartum course for mother and newborn was normal through the first 3 postpartum days. MANA #RISE2020 is an online conference produced by the Midwives Alliance of North America hosted by GOLD Learning. A Public Health Ethics Analysis of the Criminalization of Direct Entry Midwifery. Outcomes of care for 16,925 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. U.S. Department of Health and Human Services Web site, The Privacy Rule. Subsequently, in 2011 the Birthplace in England Collaborative Group reported findings from a prospective study of 64,538 births among low‐risk women in England.2, 13 Investigators concluded that for healthy women, adverse maternal and newborn outcomes were extremely rare, regardless of birth setting. The median birth weight was 3629 g (interquartile range, 3317 g‐3969 g). GOLD Learning is excited to partner with Midwives Alliance of North America (MANA) and bring the latest education to your doorsteps. Melissa Cheyney PhD, CPM, LDM, is Associate Professor of Medical Anthropology at Oregon State University.
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