Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Autor: Melissa Cheyney, Kathrin Stoll, Timothy J. Fisher, Renee Ann Cramer, Emma Butt, Holly Powell Kennedy, Eugene Declercq, Y. Tony Yang, Saraswathi Vedam, Marian F. MacDorman
Rok vydání: 2017
Předmět:
Scope of practice
Nurse Midwives
Physiology
Maternal Health
Breastfeeding
lcsh:Medicine
Pediatrics
Health Services Accessibility
Midwives
Labor and Delivery
0302 clinical medicine
Pregnancy
Medicine and Health Sciences
Birth Weight
030212 general & internal medicine
Medical Personnel
lcsh:Science
030219 obstetrics & reproductive medicine
Multidisciplinary
Pregnancy Outcome
Obstetrics and Gynecology
Place of birth
Health equity
Professions
Breast Feeding
Physiological Parameters
Female
medicine.symptom
Psychology
Research Article
Washington
Death Rates
Birth weight
Preterm Birth
03 medical and health sciences
Patient safety
Population Metrics
medicine
North Carolina
Humans
Maternal Health Services
Healthcare Disparities
Population Biology
lcsh:R
Body Weight
Biology and Life Sciences
Neonates
United States
Pregnancy Complications
Low birth weight
People and Places
Birth
Women's Health
lcsh:Q
Population Groupings
Neonatology
Breast feeding
Demography
Developmental Biology
Zdroj: PLoS ONE
PLoS ONE, Vol 13, Iss 2, p e0192523 (2018)
ISSN: 1932-6203
Popis: Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked to health disparities. Methods Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the ‘on the ground’ relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. Results MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. Conclusion The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.
Databáze: OpenAIRE
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