Midwifery Management of Pregnant Women Who Are Obese

Reither, M; Germano, Elaine; DeGrazia, Michele

doi:10.1111/jmwh.12760

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…For women in the obese II and III groups, rates of cesarean birth were about 20%, regardless of the mix of intrapartum care providers at the medical center. Because this study was not able to assess the engagement of midwives in any particular labor, this observation may reflect practice patterns in which midwives are less engaged in the care of women with increasing obesity because of restrictions in hospital or practice policies . Alternatively, the more extreme slowing of labor in many women with a higher BMI may be related to a physiologic mechanism that is not modulated by provider mix in these institutions.…”

Section: Discussionmentioning

confidence: 95%

“…Because this study was not able to assess the engagement of midwives in any particular labor, this observation may reflect practice patterns in which midwives are less engaged in the care of women with increasing obesity because of restrictions in hospital or practice policies. 31 Alternatively, the more extreme slowing of labor in many women with a higher BMI may be related to a physiologic mechanism that is not modulated by provider mix in these institutions. This analysis also assessed the effect of midwifery presence on the rate of cesarean birth performed for the diagnosis of labor dystocia.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26][27][28][29] However, few previous studies have examined the influence of midwifery care on birth outcomes among women with higher risks of complications, such as women with obesity. 30,31 Previous analysis by this research group using the Consortium on Safe Labor (CSL) data set showed an association between the hospital unit-level presence of midwives and fewer labor interventions and cesarean births in both nulliparous 32 and multiparous women. 33 However, it is unknown if CSL institutions with intrapartum care provider teams that include midwives had similar benefits for pregnant women who were at higher risk of cesarean because of obesity.…”

Section: Introductionmentioning

confidence: 99%

“…Midwifery‐led care may also be associated with a lower risk of cesarean birth; in comparisons of midwife‐led with physician‐led care for women of

similar risk factors, midwives waited longer prior to using medical interventions, and their patients had lower rates of labor interventions and cesarean birth . However, few previous studies have examined the influence of midwifery care on birth outcomes among women with higher risks of complications, such as women with obesity …”

Section: Introductionmentioning

confidence: 99%

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Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

Carlson

Breman

Neal

et al. 2019

J Midwife Womens Health

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Introduction: Maternal obesity is associated with slow labor progression and unplanned cesarean birth. Midwives use fewer medical interventions during labor, and the women they care for have lower cesarean birth rates, compared with low-risk, matched groups of women cared for by physicians. The primary aim of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Unit-level presence of midwives was analyzed as a representation of a unique set of care practices that exist in settings where midwives work. Methods: A retrospective cohort study was conducted using Consortium on Safe Labor data from low-risk, healthy women who labored and gave birth in medical centers with (n = 9795) or without (n = 13,398) the unit-level presence of midwives. Regression models were used to evaluate for associations between unit-level midwifery presence and 1) the incidence of unplanned cesarean birth and 2) in-hospital labor durations with stratification by maternal BMI and adjustment for maternal demographic and pregnancy factors. Results: The odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women at who gave birth at centers without midwives (adjusted odds ratio, 0.84; 95% CI, 0.77-0.93). However, women whose BMI was above 35.00 kg/m 2 at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. In-hospital labor duration prior to unplanned cesarean was no different by unit-level midwifery presence in nulliparous women whose BMI was above 35.00 kg/m 2. Discussion: Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Midwifery‐led care may also be associated with a lower risk of cesarean birth; in comparisons of midwife‐led with physician‐led care for women of

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

Carlson

Breman

Neal

et al. 2019

J Midwife Womens Health

View full text Add to dashboard Cite

show abstract

“…Organisation characteristics include the number of care providers involved in care provision, location, communication, collaboration, and geography [30,58,69,93,[99][100][101][102][103][104][105][106][107][108][109][110][111][112][113]. Health care providers' perceived risk, knowledge, expertise, confidence, personal views, awareness and attitude, financial considerations and women's characteristics and preference, amongst others, are described as decisive factors [17][18][19]26,46,[86][87][88]95,99,100,105,107,109,[114][115][116][117][118]. Providers' behaviour is considered influenceable via, for example, education [97,[119][120][121], and guidelines [19,97,115,122].…”

Section: Risk Selection As a Practice: Detecting And Assessing Risk mentioning

confidence: 99%

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

et al. 2020

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Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make crosssetting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.

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Midwives perceptions of managing pregnancies complicated by obesity: A mixed methods study

et al. 2022

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Midwifery Management of Pregnant Women Who Are Obese

Cited by 9 publications

References 24 publications

Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

Midwives perceptions of managing pregnancies complicated by obesity: A mixed methods study

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