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Midwives Alliance of North America (MANA) Invites You to Research Home Birth!

October 31st, 2013 by avatar

This past weekend I attended the Midwives Alliance of North America (MANA) annual conference; Birthing Social Change in Portland, OR. The conference was attended by more than 300 midwives and their supporters. I thoroughly enjoyed the variety of general sessions and the concurrents I attended. Eugene DeClerq, (did you know he is an LCCE!) a principal investigator on the Listening to Mothers project and the genius behind the Birth by the Numbers website, was brilliant as usual in sharing all kinds of data about the state of birth in the USA. Another keynote speaker, Melissa Cheyney, PhD, CPM, LDM, Division of Research Chairperson for MANA, provided members with an update on the MANA Stats Project. The MANA Stats Project is a multi-year registry collecting data mostly about out-of-hospital births, though some Certified Nurse Midwives are using it for tracking both home and hospital births as well.

At the conference, two much-anticipated research studies were announced. You can learn more about the articles and MANA stats in a recent post at the MANA blog here. Science & Sensibility is looking forward to sharing a review and information about these studies with you here on our blog in the early part of next year, when they are released in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

The MANA Stats registry is currently collecting more than 1,000 records per month, mostly from midwives who attend out of hospital births in the United States. The first set of records – representing more than 20,000 births – is currently available to researchers. According to Melissa Cheyney, “These datasets include some of the only U.S. data that exists regarding physiologic, low-intervention labor and birth — data that are becoming more and more rare due to the increase in “routine” interventions in the hospital setting.”

As the data set grows and more records are added, the power and possibility of exploring information contained gets even more exciting. Did you know that the data is being made available to researchers interested in conducting some analysis? Could this be you? Professionals may think that they need to be affiliated with a large research institution, but that is not the case.

All researchers applying for the data are required to have what’s known as “IRB approval,” meaning an academic institution willing and able to ensure that the research design appropriately protects the subjects’ confidentiality. However, MANA has a unique program in place that allows non-academic researchers to access the data. The program connects mothers, advocates, and others interested in research with researchers that can provide support and mentorship. You can learn more about this program – called “ConnectMe” – here 

It would be wonderful if a Lamaze Certified Childbirth Educator with the skill and abilities to do some analysis joined forces with researchers through the “ConnectMe” program and this information could be published in a professional journal! The possibilities are endless. Do you think this could be you?

It was interesting and exciting to spend time with all the midwives who are working every day to to help women and babies experience safe, healthy births and are practicing the Lamaze International Six Healthy Birth Practices that we know leads to better birth outcomes.

For more information for researchers to learn more about the dataset and how to apply, click here.

Childbirth Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Home Birth, Midwifery, New Research, Research, Research Opportunities , , , , , , , , ,

Maternity Support Survey – Critical Research on Under-Studied Maternity Roles

January 22nd, 2013 by avatar

 

photo:Dawn Thompson, improvingbirth.org

I’d like to draw your attention to a very important study that is currently looking for participants – The Maternity Support Survey. This comprehensive study is the first to compare doulas, childbirth educators, and labor and delivery nurses, working in the United States and Canada, in terms of their approach to maternal support and care. The survey explores these individuals’ knowledge and attitudes toward current childbirth practices, technologies and support.  Now is your opportunity to share how you view your responsibilities.  This research team wants to hear from you!

The team behind the research has been working for over two years via conference calls to develop the survey and methodology.   The research team consists of Louise M. Roth, PhD, (Principal Investigator), Christine Morton, PhD (Co-PI and regular contributor to this blog), Marla Marek, RNC, BSN, MSN, PhD(c), Megan Henley, Nicole Heidbreder BSN, MA, Miriam Sessions, Jennifer Torres, and Katie Pine, PhD.  They are sociologists and nurses, working in California, Arizona, Washington DC, Michigan, and Wyoming.  To raise funds for the project, they launched an Indiegogo campaign and have been featured on the Every Mother Counts blog.  The Maternity Support Survey has been approved by the Institutional Review Board of the University of Arizona, and Louise M. Roth, PhD, is the Principal Investigator of the study.

I’m sure the readers of this blog are aware that research has shown that support during labor and delivery has a significant impact on method of delivery, maternal and neonatal morbidity, and rates of postpartum depression. Yet existing research in maternity care has largely focused on how mothers and families view their care or on the perspectives of midwives and obstetricians, with less attention to the views of individuals who provide support to women during pregnancy and birth. The Maternity Support Survey is addressing this need.

Topics that the survey investigates include: whether doulas and childbirth educators view their maternity support work as a career, how doulas and childbirth educators establish their expertise, how technology affects workload among labor and delivery nurses, how maternity support workers are affected by managed care and litigation concerns, and emotional burnout among maternity support workers.

The Maternity Support Survey has partnered with Lamaze International and the following organizations in the recruitment of participants: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN); Birthing from Within; International Childbirth Education Association (ICEA); BirthWorks; DONA International; toLABOR (formerly ALACE); and CAPPACanada.  These organizations felt that this research was important enough to reach out to their collective members with a request for participation.

The survey launched in November 2012 – the organizations above sent emails to their members, along with monthly reminders.  By early mid January 2013, the survey had logged 1500 responses, with relatively equal numbers of each group responding.  Then, the research team decided to extend the reach of the survey to those doulas, CBEs and L&D nurses BEYOND the membership organizations.  A viral social media blitz ensued, with positive results.  Within a week, the survey logged an additional 600 responses.  As of January 21, 2013, the survey has been completed by just over 2100 respondents.  Doulas now comprise about 44%, with L&D nurses at 35% and CBEs at 33% of the total respondents.  The survey will be open through mid-March, so there is still time to share widely among your networks.  Data cleaning will happen in April, and analysis will begin in May 2013.  The researchers plan to disseminate their findings at conferences and publish in journals of interest to these occupational groups as well as in sociology and other fields.

Those of you who are members of these organizations may have already received an email with a link to the survey (and hopefully have already completed it). However, if you are not a member of one of these national organizations OR have NOT received an email from your organization inviting you to take the survey, here’s how you can share your views:

The survey is available online for US residents here.

The survey is available online for Canadian residents here.

The survey takes approximately 30 minutes to complete, and participation is entirely voluntary. The research team will NOT have any way of personally identifying you or your responses, and will not contact you for any purposes unrelated to this survey or give your information to any commercial organizations. For questions or feedback, please contact Louise M. Roth, PhD.

 

Childbirth Education, Lamaze International, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Research, Research Opportunities , , , , , , ,

ACOG’s “reVITALize” Project Wants Your Opinion!

December 20th, 2012 by avatar

By Christine H. Morton, PhD

The American Congress of Obstetricians and Gynecologists (ACOG) has undertaken the reVITALize Project and they want your help, thoughts and input. A significant revolution is underway in maternity care.  With increased attention on maternal health outcomes, the measurement and reporting of key maternal quality metrics is on the agenda of childbearing women, maternal health advocates, payers and purchasers, hospitals, regulatory agencies and maternity care clinicians.    An important element of this revolution is an effort to clearly define what we mean when we talk about pregnancy and childbirth in the data sources most utilized in developing these measures – patient medical charts, registries, electronic medical records, patient discharge data, and our vital statistics (birth certificates).

This is an important and critical opportunity for all stakeholders in US Maternity Care to contribute to the national dialogue on measuring maternal health outcomes.

From the ACOG website: 

The reVITALize Obstetric Data Definitions Conference in early August 2012 brought together over 80 national leaders in women’s health care with the common goal of standardizing clinical obstetric data definitions for use in registries, electronic medical record systems, and vital statistics. Over the course of the two-day in-person meeting and the months that followed, more than 60 obstetrical definitions were reviewed, discussed, and refined.  Data elements included: induction of labor, gestational age and term, parity, TOLAC, and more. The full executive summary of the reVITALize Obstetric Data Definitions Conference can be read here.

The public comment period for the definitions of these data elements ends January 15, 2013. To submit comments, click on one of the category links below to open the respective Public Comment form. The data elements contained within each Public Comment form have been grouped according to category; the data elements assigned to each category are listed under the category heading below. You are permitted to comment on any number of categories. You can also view an alphabetical listing of all data elements available for comment here.

Delivery
• Cesarean Delivery
• Date of Delivery
• Forceps Assistance
• Malpresentation
• Perineal Lacerations
• Placenta Accreta
• Primary Cesarean Delivery
• Repeat Cesarean Delivery
• Shoulder Dystocia
• Spontaneous Vaginal Delivery
• Vacuum Assistance
• Vaginal Birth After Cesarean
• Vertex Presentation

Gestational Age & Term
• Preterm
• Early Term
• Full Term
• Late Term
• Post Term
• Estimated Date of Delivery
• Gestational Age (calculation formula)

Labor
• Artificial Rupture of Membranes
• Augmentation of Labor
• Duration of Ruptured Membranes
• Induction of Labor
• Labor
• Labor After Cesarean
• Non-Medically Indicated Induction of Labor or Cesarean Delivery
• Number of Centimeters Dilated on Admission
• Onset of Labor
• Pharmacologic Induction of Labor
• Physiologic Childbirth
• Pre-Labor Rupture of Membranes
• Spontaneous Labor and Birth
• Spontaneous Onset of Labor
• Spontaneous Rupture of Membranes

Maternal Indicators: Current Co-Morbidities and Complications
• Abruption
• Antenatal Small for Gestational Age
• Any Antenatal Steroids
• Clinical Chorioamnionitis
• Depression
• Early Postpartum Hemorrhage
• Oligohydramnios – HOLD; Pending Further Revision
• Polyhydramnios – HOLD: Pending Further Revision

Maternal Indicators: Historical Diagnoses
• Chronic Hypertension
• Gravida
• Maternal Weight Gain During Pregnancy
• Non-Cesarean Uterine Surgery
• Nulliparous
• Parity
• Plurality
• Positive GBS Risk Status
• Pre-Gestational Diabetes

How to Submit Effective Comments

In order to make the process as productive as possible, please keep the following in mind when commenting:

• Be clear. Clearly identify the issues on which you are commenting and explain your reasons for your position.
• Be concise. Although there is no minimum or maximum requirement for comments, it is best to keep your comments short and to the point.
• Suggest alternatives. If you identify a problem with the proposed definition on which you are commenting, consider suggesting an alternative.
• Spread the word. If you know others who can provide helpful comments, please direct them to www.acog.org/revitalize  for more information.

What happens to comments after they are submitted?

http://flic.kr/p/8Box52

All comments received during the Public Comment period will be reviewed and logged for consideration and careful review by reVITALize leadership. The leadership teams are comprised of both clinical and operational members. Comments will be reviewed and responded to accordingly and will help to form the basis for any additional changes that need to be made to the refined definitions prior to final approval. Should comments require further clarification, the individual submitting the comment may be contacted during the review period to obtain any clarifying information needed to make an informed and appropriate decision regarding a potential revision.

Thank you for your help in making this initiative a success! Any questions or concerns should be directed to QI@acog.org

ACOG, Evidence Based Medicine, Guest Posts, Legal Issues, Maternal Quality Improvement, Research, Research Opportunities , , , ,

Pre-conception Treatment of Periodontal Disease as a Way to Reduce the Incidence of Preterm Births and Low Birth Weight Infants

August 30th, 2011 by avatar

Preterm delivery, delivery before 37 completed weeks of gestation, has been shown to cause  significant morbidity in infants and to be a cause of lifelong health problems in these children. The World Health Organization (WHO) reports,

 

Preterm birth is a leading cause of neonatal and infant mortality as well as short- and long-term disability. Rates for preterm birth range between 6% and 12% in developed countries and are generally higher in developing countries. About 40% of all preterm births occur before 34 weeks and 20% before 32 weeks. The contribution of these preterm births to overall perinatal morbidity and mortality is more than 50%.”

 

Low birth weight—below 5 lbs 8 ounce (or 2500 grams)—is usually a consequence of preterm birth but is also a singularly significant cause of morbidity and mortality in neonates and children. According to the March of Dimes, 67% of preterm infants are low birth weight and in the United States, they estimate that about 1 in every 12 infants is born low birth weight.

 

Despite attempts to positively impact maternal health and nutrition, and aggressively treat preterm labor, the rates of preterm birth and low birth infants are still on the rise globally. Physicians and researchers continue to examine cases and studies trying to identify potential causes and treatments that could slow, halt and eventually reverse these trends. In 1996, Offenbacher et al first reported an association between periodontal disease and preterm birth. Since that time, evidence has been growing to support the idea that periodontal disease may be associated with preterm birth, low birth weight and other adverse birth outcomes.

 

Xu Xiong et al hypothesize in their article, Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?, that since periodontal disease treatment during pregnancy has not been shown to significantly reduce the rates of preterm birth and low birth weight, that preconception treatment (either in the year prior to conception in primiparas or between pregnancies in multiparous women) may be more effective.

 

Xiong and his colleagues reached this conclusion following a systematic review of the observational studies which showed that there is an association between periodontal disease and adverse birth outcomes (especially in lower socioeconomic populations), and meta analyses of randomized control trials (RCT’s); one in which preterm birth was the end point and one in which low birth weight was the end point. RCT’s performed in low to middle-income countries found a stronger link between treatment of periodontal disease during pregnancy and reduction in adverse pregnancy outcomes. RCT’s performed in high income countries such as the United States only showed that treating periodontal disease during pregnancy may reduce the rates of low birth weight. With these findings, Xiong and his colleagues present the following recommendations for future RCT’s to determine whether or not treating periodontal disease prior to conception can actually reduce the rates of preterm birth, low birth weight and other adverse pregnancy outcomes.

 

  • Study participants would be women planning to conceive within one year and with documented periodontal disease
  • Participants would be randomized to treatment vs. non treatment groups
  • Treatment groups would receive intense periodontal therapies and use of antibiotics to aggressively treat and eradicate periodontal disease
  • Endpoints of the studies would be delivery, and assessment of rates of adverse pregnancy outcomes would determine the efficacy of the intervention.

 

Xiong et al hypothesize that if preconception periodontal treatments reduce adverse pregnancy outcomes lowering infant morbidity and mortality, then improving oral health prior to pregnancy could be recommended, especially in low and middle income nations, as a means of reducing infant morbidity and mortality worldwide.

 

At face value Xiong’s hypothesis may seem like a lot of “ifs.” However, the presumed link between periodontal disease and adverse birth outcomes provides a simple portal for intervention and measurement of effect. While it may be more difficult to amass study participants as most women don’t receive preconception care, Xiong suggests recruitment within communities. He also suggests training of dental professionals so that the diagnoses and treatments of periodontal disease remain as uniform as possible worldwide.

 

I agree with Xiong’s hypothesis and proposed course of action. My concern is that here in the United States, many citizens are without dental coverage and will be unable to afford the preconception periodontal treatments should they become a standard of preconception care. While women may receive treatment during the study, how will low income and/or uninsured women receive such treatment once preconception treatment becomes a recommendation? Medicaid doesn’t cover dental procedures “for health” and preconception would need to be listed as treatment of overall health and that may prove a difficult task—at least initially. Medicaid is currently facing increasing budget cuts nationwide so adding another benefit may not be admissible, despite being effective in lowering other health care costs associated with the long term care of preterm and low birth weight infants.

 

While I hope that Xiong’s hypothesis is proven and preconception periodontal treatment is a solution to help reduce the rates of preterm birth and low birth weight infants, I fear that as a solution, it may not be available to many women, especially in the United States, due to costs. I hope that worldwide, if preconception periodontal treatment is effective in reducing adverse pregnancy outcomes, resources will be allocated for such treatment as it will reduce not only infant morbidity and mortality but also the burden of life long care costs for these children.

 

 

Posted by:  Darline Turner-Lee, BS, MHS, PA-C

 

 

 

References

Stacy Beck, Daniel Wojdyla, Lale Say, Ana Pilar Betran, Mario Merialdi, Jennifer Harris Requejo, Craig Rubens, Ramkumar Menon & Paul FA Van Look

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity   Bulletin 37 World Health Organizaton 2010;88:31–38 | doi:10.2471/BLT.08.062554

 

The March of Dimes  http://www.marchofdimes.com/medicalresources_lowbirthweight.html

 

Steven Offenbacher, Vern Katz, Gregory Fertik, John Collins, Doryck Boyd, Gayle Maynor, Rosemary McKaig, and James Beck

“Periodontal Infection as a Possible Risk Factor for Preterm Low Birth Weight”

Journal of Periodontology October 1996, Vol. 67, No. 10s, Pages 1103-1113,

DOI 10.1902/jop.1996.67.10s.1103 (doi:10.1902/jop.1996.67.10s.1103)

 

Xiong X, Buekens P, Goldenberg RL, et al. “Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?” American Journal of Obstetrics and Gynecology 2011; 205:111.e1-6.

Pre-term Birth, Preconception Care, Prenatal Illness, Research Opportunities, Science & Sensibility, Uncategorized , , , ,

Saving Lives at Birth: A Grand Challenge

March 17th, 2011 by avatar

Last week, Secretary of State, Hillary Rodham-Clinton, joined the leadership team of Saving Lives at Birth for their landmark announcement–a grant program aimed at improving maternal and infant safety in developing regions.  As described on the organization’s website,

“To accelerate substantial and sustainable progress against maternal and newborn deaths and stillbirths at the community level, we need to harness the collective imagination and ingenuity of experts across a broad range of disciplines and expertise.”

 

Partner organizations in this effort include the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, Norwegian Ministry of Foreign Affairs, Grand Challenges Canada, and The World Bank.  Together, these private and governmental organizations are seeking innovative solutions to perinatal maternal and infant morbidity and mortality in rural, low-resource settings–and have issued a grand challenge:  submit your idea for an intervention that can:

  • Increase access to primary health care for women and newborns by at least 50%
  • Substantially improve the quality of care as measured by health outcomes
  • Lead to improved and sustained healthy behavior

Selected project team(s) will receive a grant that includes seed funding for the development of the project/product or funding for scaling the innovation to the point of implementation.

Three categories of innovation are sought: 

  • technology-based (devices or technologies to prevent, detect or treat maternal and newborn problems at the time of birth)
  • healthcare services demand-based (technologies/ innovations that incentivize women to seek healthcare, and knowledge of healthy behaviors that can improve birth outcomes
  • trained birth attendant based (increasing access to healthcare, training for birth attendants and methods for transporting sick moms and babies to medical facilities)

To watch the presentation of this project, go here and, please, spread the word.

Photo Courtesy of: www.savinglivesatbirth.net

 

  

Posted by: Kimmelin Hull, PA, LCCE

Maternal Mortality, New Research, Research, Research for Advocacy, Research Opportunities, Uncategorized , , , , , , ,