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Giving Birth to Midwives Newsletter                          May 2013
graduation photo

Taking AME
Association news from the President, Justine Clegg

Spring, the season of rebirth, invites us to bring renewed energy and commitment to our work as midwifery educators.  In this issue of Giving Birth to Midwives, we highlight research done by midwifery students, as well as recent evidence relevant to midwifery practice, helping you to stay current in evidence-based education. AME members and midwifery programs were all invited to contribute to this edition of GBTM.Thank you to the members, programs and students who participated.

MEAC has proposed revisions to their standards for accredited midwifery programs, based in part on the International Confederation of Midwives (ICM) standards. In March the AME Board participated in a special meeting about these proposed Standard revisions. MEAC sent out a request for feedback on these revisions from interested stakeholders, including midwifery students, program faculty, clinical educators and preceptors. The survey was open through March and closed April 30th. 

Read the full article here >

US Midwifery Education, Regulation & Association Consensus Meeting 
by Justine Clegg

On April 20-22, the national midwifery groups involved in US MERA (United States Midwifery Education, Regulation & Association) - MANA, NACPM, NARM and MEAC, and ACNM, ACME and AMCB - met for 2 days in Airlie, VA. These seven US midwifery organizations represent the three US midwifery credentials: CPM, CNM and CM. The identified goals of the US MERA meeting were to:
  • describe a history that reflects the ongoing efforts to move professional midwifery forward in the US, including identification of challenges and accomplishments,
  • engage in a dialogue that creates a deeper understanding of current strengths and challenges for US midwifery,
  • develop knowledge and trust to support successful ongoing communication,
  • identify opportunities for future collaboration,
  • conduct a collaborative analysis of the ICM's Education, Regulation, and Association pillars as they apply to U.S. midwifery. 

Read the full article here > 

 
Student Research

This issue of Giving Birth to Midwives features research done by midwifery students. Several midwifery programs require their students to complete a formal research project during the course of their education. These may take the form of a master's thesis, a lengthy research paper, or an oral presentation to the community. Highlighting these research projects honors these students, showcases the excellent quality of work coming from our educational programs, and gives educators the latest evidence-based information to include in our instructional content.


National Institutes of Health Consensus Development Conference Recommendations on Diagnosing Gestational Diabetes Mellitus
by Lisa Delorme

In March 2013, the National Institutes of Health held a development consensus conference on the diagnosis of gestational diabetes mellitus (GDM). The evidence supporting a shift from the two-step (50g GCT & 100g 3 hr GTT) to the one- step (75g 2hr GTT) approach was evaluated in order to determine the most appropriate method of diagnosis for providers in the United States. It was determined that adopting the one-step approach would increase the proportion of women diagnosed with GDM by two- to three-fold. This would increase the annual cost of the care for GDM in the United Stated from $636 million to $2 billion. It is currently unknown if the benefits of treatment outlined for women diagnosed by the two-step approach extend to women diagnosed with milder forms by the one-step approach. Benefits of the one-step approach identified by the panel included standardization between the United States and the world and some operational benefits. However, due to a lack of evidence and the concern that the adoption of the one-step approach would increase costs and interventions without clear demonstration of improvements in the most significant maternal and neonatal health outcomes, the panel recommends that diagnosis continue to be carried out with the two-step approach.

  

 

2013 National Birth Center Study II Results 
by Maya Bialy

The recently published National Birth Center Study II confirms that birth centers provide safe and first-rate care to healthy pregnant women in the US. The results provided by this study show very similar results to the original 1989 National Birth Center study.
The cesarean rate in birth centers has remained between 4.4 and 6% in the last 20 years. In comparison, the US cesarean rate is 27% for low risk women giving birth in hospitals, and 32% for all hospital births.

Midwifery-led birth centers improve the experience of care, improve the health of populations, and reduce per capita costs of health. This, and other information obtained from this study can help women and families make informed, evidence-based choices about where they would like to birth.


Read the full article here>

Non-invasive Prenatal Testing (NIPT)
by Lisa Delorme

Using a single blood test, it is now possible to screen for trisomy 21, 18 and 13 by looking at fetal DNA found in the maternal blood stream. This DNA is found free from the cell, as it results from the breakdown of fetal cells, and can therefore be differentiated from intact fetal cells left over from subsequent pregnancies. Aneuploidies are detected through quantitative or qualitative differences in the chromosomal fragments. This screen can be done any time after 10 weeks gestation but is typically performed between 10-22 weeks. It has currently been validated for use in certain populations including: advanced maternal age, positive NT/MS screen (FTS, SEQ, INT, QUAD), ultrasound finding associated with aneuploidy, and/or personal or family history of aneuploidy. The detection rate varies among the test brands, with certain tests being more sensitive for specific aneuploidies.  The detection rate for trisomy 21 is >99% and for trisomy 18 is 97.4-100%. This high detection rate means that if a woman tests negative she may be reassured of the absence of a specific aneuploidy and may choose to avoid a more invasive diagnostic procedure. Although NIPT is considered essentially diagnostic the false-positive rate is <0.1% and therefore women who test positive may choose to proceed to an amniocentesis or chorionic villi sampling. While NIPT is currently being marketed primarily for screening for trisomies, some brands can also be used to screen for certain monosomies, Rh factor in sensitized pregnancies, twins and certain sex chromosome abnormalities.

Read the full article here>

Critical Congenital Heart Disease Screening for the Out of Hospital Provider
by Lisa Delorme

Congenital heart disease is the most common congenital malformation in the newborn, affecting 5.6 out of 1000 live births in the United States annually. Out of these, 25% will have critical congenital heart disease (CCHD). Currently CCHD has been diagnosed through prenatal ultrasounds and the newborn physical exam; however, these methods are limited and 30% of newborns with CCHD are undiagnosed before circulatory collapse or death (reported in Cramer 2013). Pulse oximetry screening has been introduced as a solution, both for in and out of hospital births, to increase the diagnostic rates for CCHD. This non-invasive technique uses a light wave passing through a body part to determine the level of oxygen saturation of the hemoglobin in capillary blood. It can be used to pick up CCHDs not typically associated with cyanosis including: hypoplastic left heart syndrome, pulmonary atresia (with intact septum), tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus.  Pulse oximetry screening has a specificity of 89-100% and a false-positive rate of 0.14% when done at least 24 hours after birth by a trained provider. A reading is obtained on the right hand and either foot. If the newborn fails (1 screen <90% or three screens an hour apart between 90-94%) they should be transported immediately for pediatric evaluation.


Read the full article here>

Current Cervical Cancer Screening Guidelines
by Maya Bialy

Two separate groups updated recommendations for cervical cancer screening in 2012: the U.S. Preventive Services Task Force (USPSTF) and a multidisciplinary partnership among the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP). The current guidelines recommend that initial cervical cancer screening begin at age 21, stopping at age 65-70 if previous screens were negative. For low-risk women between ages 21-29, screening is recommended every 3 years. For low-risk women ages 30-65, it is recommended to screen with cytology every 3 years or do the combined use of cervical cytology and high-risk HPV DNA testing ("co-testing") every 5 years, "co-testing" every 5 years being the preferred choice.


Read the full article here>

2013 Recommended Immunization Schedule for Adults
by Susi Delaney

Each year the Centers for Disease Control and Prevention updates its recommended immunization schedule for adults. Several changes to the schedule were made regarding pregnancy:
  • Pregnancy is no longer considered a contraindication to the hepatitis A vaccine. Immunization to hepatitis A is now recommended for anyone with a history of illicit drug use (injection or non-injection), or other high risk factors.
  • The schedule now recommends that pregnant women receive Tdap (tetanus, diphtheria, and acellular pertussis) vaccine with each pregnancy, preferably at 27-36 weeks gestation, regardless of how much time has elapsed since the woman's last vaccination. The purpose of this vaccination is to reduce the infant's risk of severe illness and death from pertussis during its first few months of life.
  • HPV vaccines continue to not be recommended for use in pregnant women. If a woman is found to be pregnant after initiating the vaccination series, delay the remainder of the series until after pregnancy.

Read the full article here>

Institute of Medicine Birth Settings Workshop
by Maya Bialy

A public workshop was held in Washington DC on March 6-7, 2013 to review updates to the 1982 IOM-NRC report Research Issues in the Assessment of Birth Settings. Presentations and discussions highlighted research on the different models of maternity care, educational requirements of health care providers, client and provider satisfaction levels and birth outcomes in varying birth settings (hospital maternity wards, hospital-affiliated and free standing birth centers and home births).  Presenters included Holly Powell Kennedy (President, ACNM), Brynne Potter (Co-founder, Private Practice), Carol Sakala (Director of Programs, Childbirth Connection), and others. Video recordings and presentation materials from the workshop can be found on the workshop's webpage.


Read the full article here>

Upcoming Events

May 30-31, 2013 (Ann Arbor, MI) - Reproductive Justice: Activists, Advocates, Academics in Ann Arbor - this conference is FREE!

October 11-13, 2013 (New Orleans, LA) - Lamaze International 2013 Annual Conference

October 24-27, 2013 (Portland, OR) - MANA 2013 "Birthing Social Change"

October 25-27, 2013 (Destin, FL) - CAPPA Conference "Destined to make a Difference"

October 30-November 3, 2013 (Blankenberge, Belgium) - Midwifery Today Conference "Autonomous Midwifery: The Key to the Future".

November 6-9, 2013 (London, Ontario) - Birth and Beyond Conference

Issue: 9 
Teaching doll
:: IN THIS ISSUE ::
US Midwifery Education, Regulation & Association Consensus Meeting
Student Research
National Institutes of Health Consensus Development Conference Recommendations
2013 National Birth Center Study II Results
Non-invasive Prenatal Testing
Critical Congenital Heart Disease Screening for the Out of Hospital Provider
Current Cervical Cancer Screening Guidelines
2013 Recommended Immunization Schedule for Adults
Institute of Medicine Birth Settings Workshop
UPCOMING EVENTS

ANNOUNCEMENTS  

NACPM Fellowship Program - Get involved in the national midwifery community through a fellowship with the National Association of Certified Professional Midwives. Click here for more information.

The American Academy of Pediatrics recently issued Guidelines for the Care of Infants in Planned Home Births. Read more here.

Listening to Mothers Survey III results were recently released! Click here to read more.

Join Our Mailing List

FEATURED
RESOURCES 

Following are several of our favorite resources related to epidemiology and research methods:

* Cluett, E. & Bluff, R. (2006). Principles and Practice of Research in Midwifery (2nd ed.). London: Churchill Livingstone. ISBN 978-0443101946.

* Rees, C. (2012). Introduction to Research for Midwives (3rd ed.). London: Churchill
Livingstone. ISBN 978-0702051654.

* Epidemiology Basics (video)

* Science and
Sensibility blog


We update our resources regularly! Do you know of resources that are helpful to other midwifery educators? Or, are you seeking particular resources that are not currently available on the website? Send your ideas to  info@association
ofmidwiferyeducators.org
.


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Among us there is a wealth of expertise and knowledge. Sharing is the best way for us to strengthen midwifery education and to form strong bonds between educators. Together, we truly are greater than the sum of our parts. We welcome your articles, resources, or suggestions for themes or articles for the future. 

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Association of Midwifery Educators