Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. Breast cancer survivors' risk of interval cancers and false positive results in organized mammography screening. The majority of births in the sample were attended by CPMs (79.2%). Effectiveness of an oral health education programme for older adults using a workbook. Professional perspectives on planned home births. Addition of your name to the midwife referral list. This observed rate and CI are statistically congruent with rates reported by Johnson and Daviss4 and Kennare et al30 but are higher than the intrapartum death rates reported by de Jonge et al,10 Hutton et al,12 and Stapleton et al.14 While the absolute risk44 is still quite low, the relatively elevated intrapartum mortality rate in our sample may be partially a function of the higher risk profile of the MANA Stats sample relative to de Jonge et al,10 Hutton et al,12 and Stapleton et al14 whose samples contain primarily low‐risk, singleton, vertex births. 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). Discounts to conferences in both the U.S. and Mexico with Spanish and English tracks. Of the 127 breech neonates born vaginally, 92% were born at home. Use the link below to share a full-text version of this article with your friends and colleagues. Summary: This is the largest study to-date on outcomes of planned, midwife-attended homebirths in the United States Outcomes of Care for 1,892 Doula-Supported Adolescent Births in the United States: The DONA International Data Project, 2000 to 2013. 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. Contraindications in planned home birth in Iceland: A retrospective cohort study. Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, & Vedam S. Outcomes of care for 16,984 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004-2009. Outcomes of care for 16,925 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. Its stated goal is to unify and strengthen the profession of midwifery, thereby improving the quality of health care for women, babies, and communities. Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. However, some have suggested that these outcomes are not generalizable to the United States because there currently is no integrated maternity care system with clear communication between birth settings and across provider types.16, 17 Rising rates of home and birth center births, in the absence of a unified, national policy on choice and interprofessional collaboration across birth settings, are a major concern.18 In addition, without established systems for universal maternity care data collection, it is difficult to evaluate the quality and safety of care across birth settings and by multiple provider types. Mother–newborn dyads transferred during the intrapartum period are not at risk of postpartum or neonatal transfer. Death occurred at the mother's home on the third day postpartum in the afternoon, following a morning visit by the midwife during which all vital signs had been normal. 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. 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). First, we suspect that the MANA Stats rates for postpartum hemorrhage may be unreliable because they are dependent on visual estimation of blood loss, which has been shown to be highly inaccurate across provider types and birth setting.39, 40 Second, because active management of third stage is less frequent in this sample, and because so few of the women in MANA Stats had intravenous oxytocin administered at the time of birth, our findings call into question, as have other studies,36, 41-43 whether 500 mL is an appropriate benchmark for the diagnosis of postpartum hemorrhage in a physiologic birth population. She is also a board member and Director of Equity Initiatives for the Association of Midwifery Educators. Officers were chosen and a newsletter Practicing Midwife (changed to MANA News in 1983) was established. The same pattern was seen for multiparous women with a history of cesarean undergoing a trial of labor after cesarean (TOLAC): an increased risk of intrapartum fetal death, when compared to multiparous women with no prior cesarean (2.85/1000 TOLAC vs 0.66/1000 multiparas without a history of cesarean, P = 0.05; Table 5), but no increase in neonatal death. 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. Nationwide, midwives or midwifery practices from 43 states actively participate. Of the 6 newborns that died in the late neonatal period, 2 were secondary to cord accidents during birth, and the causes of the remaining 4 deaths were unknown. It is difficult to compare birth‐related mortality statistics across studies; there are so few death outcomes that statistical power is quite low. Other reported reasons for intrapartum transfer included desire for pain relief (n = 281, 15.2%), fetal distress or meconium (n = 185, 10.0%), malpresentation (n = 118, 6.4%), and maternal exhaustion (n = 98, 5.3%). 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. Utah obstetricians’ opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study. 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. 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. Fewer than 1% of newborns were low birth weight (<2500 g), although almost one‐quarter were macrosomic (> 4000 g) (Table 3). 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. and you may need to create a new Wiley Online Library account. The spontaneous vaginal birth rate for the sample was 93.6%. At pains to consent: A narrative inquiry into women's attempts of natural childbirth. This National Birth Center Study II reported excellent outcomes and reduced interventions as a result of midwifery‐led care in birth centers. These records were subjected to 3 postsubmission review processes, described in detail elsewhere.5 All data forms indicating maternal, fetal, or newborn deaths also underwent detailed case review using a modified fetal‐infant mortality review approach.22, 23 Analysis of pre‐ and postreviewed variables during quality testing evidenced near perfect agreement, suggesting that MANA Stats 2.0 data were entered with a high degree of accuracy by midwives.5 Thus, any errors in the dataset are likely random rather than systematic. 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. ", "Development and Validation of a National Data Registry for Midwife-Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset,". Nonetheless, it is useful to compare death rates associated with planned home and birth center births, as reported across a variety of geographic settings (although confidence intervals around the rates are large) because any potential differences observed can serve to generate hypotheses for future work. 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. Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making. Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: How accurate and consistent are health‐care professionals? Hosted on IP address 184.172.57.92 in Dallas, United States. In mid-2011 the current data form was launched, also developed using the CBPR model. This multiparous mother had no antenatal or intrapartum risk factors. Data were analyzed according to intended and actual place of birth. Saraswathi Vedam, CNM, RM, MSN, FACNM, SciD(hc), is an Associate Professor in the Faculty of Medicine at the University of British Columbia. GOLD Learning is excited to partner with Midwives Alliance of North America (MANA) and bring the latest education to your doorsteps. Epub 2014 Jan 30. 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. 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). 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. Pregnancy, Birth and the COVID-19 Pandemic in the United States. 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. 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. 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. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants. Web site and data forms ©2004-2020 Midwives Alliance, "Outcomes of planned home births with certified professional midwives: large prospective study in North America,", "Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey. Complete demographic characteristics for the sample are reported in Table 2. Intrapartum Care and Experiences of Women with Midwives Versus Obstetricians in the Listening to Mothers in California Survey. There is some evidence of increased intrapartum fetal death associated with TOLAC; however, the total number of events was too low for reliable analysis. DOI: 10.1111/jmwh.12172. At 6 weeks postpartum, 97.7% (n = 16,338) of newborns were at least partially breastfed. Born at Home: Cultural and Political Dimensions of Maternity Care in the United States, Home‐birth emergencies in the US and Mexico: The trouble with transport, Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths, Examining autonomy's boundaries: A follow‐up review of perinatal mortality cases in UK independent midwifery, The value of the perinatal and neonatal autopsy, Secondary Data Sources for Public Health: A Practical Guide, Methodology, design, and analytic techniques to address measurement of comorbid disease, What they fill in today, may not be useful tomorrow: Lessons learned from studying medical records at the Women hospital in Tabriz, Iran, Clinical Research: Concepts and Principles for Advanced Practice Nurses. 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. 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. Differentiating Research, Quality Improvement, and Case Studies to Ethically Incorporate Pregnant Women. Multiagent therapy with pomalidomide, bortezomib, doxorubicin, dexamethasone, and daratumumab (“Pom‐PAD‐Dara”) in relapsed/refractory multiple myeloma. 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. Of the 168 women with GDM, preeclampsia, eclampsia, or Rh sensitization, 74 had at least one prenatal visit with an obstetrician, and 47 had at least 3 prenatal visits with an obstetrician (an additional 33 women did not have data on obstetrician visits). Bioethics, Public Health, and the Social Sciences for the Medical Professions. 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. Washington State Childbearing Women’s Experiences of Planned Home Births: A Heideggerian Phenomenological Investigation. The most common reason for transfer was failure to progress (n = 752, 40.7% of intrapartum transfers). What Is A CPM. 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. When examining perinatal death rates among higher‐risk women, the data suggest that compared to neonates born in vertex presentation, neonates born in breech presentations were at increased risk of intrapartum death (1.09/1000 vertex vs 13.51/1000 breech, P < 0.01), early neonatal death (0.36/1000 vertex vs 4.57/1000 breech, P = 0.09), and late neonatal death (0.30/1000 vertex vs 4.59/1000 breech, P = 0.08). Data are stored on a secure server with encryption software congruent with privacy and security measures for protected health information, as defined by the United States Department of Health and Human Services.20, 21 Upon enrollment in the project, midwife contributors are provided with detailed instructions on the use of the online data collection tool; and data collection support team members, known as data doulas, provide e‐mail and phone support to all contributors. Introduction: Data on the safety of waterbirth in the United States are lacking. 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. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. 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. She serves as Senior Advisor to the MANA Division of Research and practices as a registered midwife in Vancouver, British Columbia. Olsen and Clausen,15 in their 2012 Cochrane systematic review, suggest that while evidence from randomized controlled trials sufficiently powered to assess differences in perinatal mortality by birth site may never be available, the balance of evidence from large well‐designed observational studies supports informed choice of birth place in jurisdictions where integrated maternity systems exist. Abbreviations: MANA, Midwives Alliance of North America; NICU, neonatal intensive care unit; TOLAC, trial of labor after cesarean. The role of Cor‐Knot in the future of cardiac surgery: A systematic review. 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. 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. Briefly, most women in this sample were white, college‐educated, and married. Web site and data forms ©2004-2020 Midwives Alliance Low Apgar scores (< 7) occurred in 1.5% of newborns. Of the 1850 newborns born in the hospital following an intrapartum transfer, 3.7% (n = 69) had a 5‐minute Apgar score below 7. Nulliparous women required transfer during labor 3 times as frequently as multiparous women (Table 4). Cheyney, M et al, 30 January 2014. Home birth: What are physicians’ ethical obligations when patient choices may carry increased risk? She is also a Certified Professional Midwife in active practice, and the Chair of the Division of Research for the Midwives Alliance of North America where she directs the MANA Statistics Project. 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. 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. It appeared in the same issue of the Journal of Midwifery and Women's Health. Statistically downscaled precipitation sensitivity to gridded observation data and downscaling technique. Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. Trabecular bone deterioration in differentiated thyroid cancer: Impact of long‐term TSH suppressive therapy. In addition, the data entered into the MANA Stats system come from medical records. Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth, Part 1. Neonatal Outcomes in the Birth Center Setting: A Systematic Review. Breech birth at home: outcomes of 60 breech and 109 cephalic planned home and birth center births. 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). Click here for more information about the referral list. 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. Preoperative dental screening prior to cardiac valve surgery and 90‐day postoperative mortality. The establishment of reliable and inclusive tools for US‐based perinatal data collection has become a priority. 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. Twenty‐two percent of the sample was nulliparous, and 9.2% of multiparous women were grand multiparas (≥ 5 previous births after 20 weeks’ gestation). It is unclear whether the increased mortality associated with higher‐risk women who plan home births is causally linked to birth setting or is simply consistent with the expected increase in rates of adverse outcomes associated with these complications. For more information on Midwives: American College of Nurse-Midwives; Citizens for Midwifery ; Footnotes: 1. She is also the Director of Research Education for the MANA Division of Research and faculty at the Midwives College of Utah. 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. There was no evidence of increased risk of death among multiple births. Furthermore, our pre‐/postdata review analysis indicated that data were initially entered with a high degree of accuracy.5 Finally, we cannot confirm with 100% certainty that participating midwives entered data from all of their clients. Acta Obstetricia et Gynecologica Scandinavica. For the purposes of this analysis, we excluded women who transferred care to another provider prior to the onset of labor, women who at the onset of labor had a planned birth location other than home, and women who did not live in the United States. Journal of Midwifery & Women’s Health, 59(1): 17-27. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. U.S. Department of Health and Human Services Web site, Women's and Children's Health Policy Center, Fetal and Infant Mortality Review (FIMR) in Brief, Fetal and Infant Mortality Review (FIMR): A Strategy for Enhancing Community Efforts to Improve Perinatal Health, Evaluation of 280,000 cases in Dutch midwifery practices: A descriptive study, Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies, Listening to Mothers III: Pregnancy and Birth, Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences, Planned home and hospital births in South Australia, 1991–2006: Differences in outcomes, Vaginal birth after cesarean: New insights on maternal and neonatal outcomes, Vaginal birth after cesarean: New insights, National Institutes of Health consensus development conference statement: vaginal birth after cesarean: New insights. 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 … Despite attempts to design a randomized controlled trial, sufficient numbers of women have not consented to be randomized according to birth site.9. We would like to thank Bruce Ackerman for his countless hours of volunteer work as Director of Data Collection; Ellen Harris‐Braun for her tireless attention to detail as Director of Database Development; and Trinlie Wood, Contributor Enrollment and Consent Manager, for her seemingly endless dedication to the MANA Statistics Project. Low‐risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes. 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). Unwarranted Variation in Utilization of Cesarean Birth Among Low‐Risk Childbearing Women. 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. 2014 May-Jun;59(3):366. doi: 10.1111/jmwh.12209. Their vision has helped bring the project to where it is today. 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). Swimming against the tide: Women's experience of choosing a homebirth in Switzerland. In 2009, 3 well‐designed, population‐based cohort studies were published comparing planned home births to planned hospital births with professional midwives as attendants. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. She is also a Certified Professional Midwife in active practice, the Chair of the Governor-appointed Board of Direct-entry Midwifery for the State of Oregon, and the Chair of the Division of Research for the Midwives Alliance of North America where she directs the MANA Statistics Project. About the project. 2) What are the characteristics of midwife‐led care that contribute to safe physiologic birth? About the project. There were no significant differences in intrapartum death, neonatal death within 24 hours or 7 days after birth, or rates of neonatal intensive care unit (NICU) admissions. You can find similar websites and websites using the same design template.. Mana.org has an estimated worth of 3,393 USD. 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). Please check your email for instructions on resetting your password. This is a project of the Division of Research of the Midwives Alliance of North America, an organization inclusive of all forms of midwifery. Since 1982, MANA has been bringing together midwives from all types of backgrounds to create strength and solidarity among midwives in North America. Melissa Cheyney, PhD, CPM, LDM, is an Associate Professor of medical anthropology and reproductive biology in the Department of Anthropology at Oregon State University in Corvallis, Oregon. Department of Health and Human Services web site, the site launched a new light: the Midwives College Utah... Times as frequently as multiparous women ( Table 4 ) ( Tables 3 4. Reported in Table 2 Project web site was launched in early 2009, 3 well‐designed, population‐based cohort studies published. New light: the Midwives Alliance of North America ( MANA Stats of interval cancers and positive! Of midwife‐led care that contribute to safe physiologic birth most of these were primary cesareans ( 84.4 %.... 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