Pregnancy and birth have been conceptualized as medically problematic, with all pregnant women considered at risk and in need of medical monitoring. Universal application of risk scoring and surveillance as preemptive strategies in an effort to reduce risk is now standard obstetric practice. Labeling women "high risk" can result in more unnecessary interventions and have negative psychologic sequelae. When perceived pregnancy risk is out of proportion to the real risk, and when risk management procedures are applied to all women with benefit for only a few, the use of technology in caring for pregnant women becomes normalized. A learned reliance on technology can diminish women's own authoritative knowledge of pregnancy and birth. This may also have the unintended consequence of contributing to birth fear, a phenomena becoming more widely recognized. Health care provider-patient communication about pregnancy risk can be presented in a manner that encourages informed compliance rather than informed choice. Evidence-based risk assessment is essential to providing optimal prenatal care. Using tools such as the Paling Palette can help health care providers present balanced and readily understood information about risk.

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The influence of dietary omega-3 fatty acids on health outcomes is widely recognized. The adequate intake of omega-3 fatty acids docasahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in particular can increase gestation length and improve infant cognitive and visual performance. Adequate levels of omega-3 fatty acids have also been shown to reduce the incidence of preterm birth in some populations. Research on prenatal omega-3 intake and other outcomes, such as preeclampsia and fetal growth restriction, is inconclusive. Women in the United States consume low levels of omega-3 fatty acids compared to omega-6 fatty acids; this dietary pattern is associated with poor health outcomes. Omega-3 fatty acids are found primarily in fish, yet many pregnant women avoid fish because of concerns about potential mercury and polychlorinated biphenyl contamination. It is important for prenatal care providers to assess women's diets for omega-3 fatty acid intake and ensure that pregnant women are consuming between 200 and 300 mg daily from safe food sources. Purified fish, algal oil supplements, and DHA-enriched eggs are alternative sources for pregnant women who do not eat fish.

The imperative for midwifery educators is to transmit to their students midwifery's unique body of knowledge and hallmarks of care that guide midwifery practice. Concerns have been raised about the ability to maintain the unique aspects of midwifery practice in a culture where routine use of intervention prevails. A theory-practice gap may lead to fewer student midwives exposed to the perspective and practices of midwifery during their clinical education. Preceptor role modeling is important to developing student confidence, conceptualized as self-efficacy, to persist in the practice of midwifery hallmark behaviors, particularly under conditions that undermine these practices. This study examined student perceptions of preceptor behaviors of two midwifery hallmarks of practice: therapeutic presence and non-intervention in the absence of complication and student self-efficacy for performing these behaviors. Recent graduates of education programs accredited by the American College of Nurse-Midwives Division of Accreditation completed researcher-developed tools regarding perceptions of preceptor behaviors of therapeutic presence and non-intervention and their outcome expectancy and self-efficacy for the same behaviors. The results indicate that preceptor behaviors influence student confidence to perform hallmark behaviors. Student belief in the value of the hallmark to benefit women is the biggest predictor of self-efficacy for hallmark behaviors. Clinical and educational implications and directions for future research are discussed.

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