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Background: Anecdotal evidence suggests that the profile of midwifery clients in British Columbia has changed over the past 20 years and that midwives are increasingly caring for clients with moderate to high medical risk. We sought to compare perinatal outcomes with a registered midwife as the most responsible provider (MRP) versus outcomes among clients with physicians as their MRP across medical risk strata. Methods: This retrospective cohort study (2008-2018) used data from the BC Perinatal Data Registry. We included all births that had a family physician, obstetrician or midwife listed as the MRP (n = 425 056) and stratified the analysis by pregnancy risk status (low, moderate or high) according to an adapted perinatal risk scoring system. We estimated differences in outcomes between MRP groups by calculating adjusted absolute and relative risks. Results: The adjusted absolute and relative risks of adverse neonatal outcomes were consistently lower among those who chose midwifery care across medical risk strata, compared with clients who had a physician as MRP. Midwifery clients experienced higher rates of spontaneous vaginal births, vaginal births after cesarean delivery and breastfeeding initiation, and lower rates of cesarean deliveries and instrumental births, with no increase in adverse neonatal outcomes. We observed an increased risk of oxytocin induction among high-risk birthers with a midwife versus an obstetrician as MRP. Interpretation: Our findings suggest that compared with other providers in BC, midwives provide safe primary care for clients with varied levels of medical risk. Future research might examine how different practice and remuneration models affect clinical outcomes, client and provider experiences, and costs to the health care system., In British Columbia, registered midwives are autonomous, primary health care providers, regulated and integrated into the publicly funded health care system. Midwives typically work in small-team continuity-of-care models, providing medical [...]

2022 FEB 26 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Nutritional and Metabolic Diseases and Conditions - Obesity [...]

Byline: A Raju Healthcare experts and members of Consumers' Council of Telangana (CCT) have expressed concern over the rising number of C-section deliveries in the state. Recently, CCT had even [...]

IN A NORMAL year, Robina Khalid might take on 70-80 clients at her midwifery practice in New York City. But 2020 has not been a normal year. She got around [...]

[CASE] Shoulder dystocia resulting in persistent injury to C5 and C6 A 30-year-old, G2P1 woman presented in labor at 39 weeks and reported a strong desire to have a natural [...]

This study investigated the reasons for continued high rates of home births in rural Shanxi Province, northern China, despite a national programme designed to encourage hospital deliveries. We conducted semi-structured interviews with 30 home-birthing women in five rural counties and drew on hospital audit data, observations and interviews with local health workers from a larger study. Multiple barriers were identified, including economic and geographic factors and poor quality of maternity care. Women's main reasons for not having institutional births were financial difficulties (n=26); poor quality of antenatal care (n= 13); transport problems (n= 11); dissatisfaction with hospital care expressed as fear of being in hospital (n= 10); convenience of being at home and continuity of care provided by traditional birth attendants (TBAs) (n=10); and belief that the birth would be normal (n=6). These barriers must all be overcome to improve access to and acceptability of hospital birth. To ensure that the national policy of improving the hospital birth rate is implemented effectively, the government needs to improve the quality of antenatal and delivery care, increase financial subsidies to reduce out-of-pocket payments, remove transport barriers, and where hospital birth is not available in remote areas, consider allowing skilled attendance at home on an outreach basis and integrate TBAs into the health system. Keywords: antenatal care, childbirth, health worker attitudes, traditional birth attendants, quality of care, privatisation, health policy and programmes, China Resume Cette etude a enquete sur les raisons expliquant pourquoi la province rurale du Shanxi, en Chine septentrionale, continue d'enregistrer un taux eleve d'accouchements a domicile, malgre un programme national d'encouragement des naissances a l'hopital. Nous avons mene des entretiens semi-structures avec 30 femmes ayant accouche a domicile dans cinq comtes ruraux et avons utilise les donnees des audits hospitaliers, les observations et les entretiens avec des agents de sante locaux realises dans le cadre d'une etude plus large. Nous avons identifie de multiples obstacles, notamment des facteurs economiques et geographiques, ainsi que la mediocrite des soins maternels. Les principales raisons decourageant les femmes d'accoucher en institution etaient les difficultes financieres (n=26) ; la mauvaise qualite des soins prenatals (n=13) ; les problemes de transport (n=ll) ; l'insatisfaction quant aux soins hospitaliers exprimee comme peur de l'hospitalisation (n=10) ; la commodite d'etre a la maison et la continuite des soins assures par les accoucheuses traditionnelles (n=10) ; et la conviction que la naissance serait normale (n=6). Il faut surmonter tous ces obstacles pour ameliorer l'acces a l'accouchement en milieu hospitalier et son acceptabilite. Afin de garantir une application efficace de leur politique nationale, les autorites doivent relever la qualite des soins prenatals et obstetricaux, augmenter les subventions financieres pour reduire les frais a la charge des patientes, resoudre les difficultes de transport et, quand l'accouchement hospitalier n'est pas disponible dans les zones reculees, envisager d'autoriser une assistance qualifiee a domicile avec du personnel mobile et integrer les accoucheuses traditionnelles dans le systeme de sante. Resumen En este estudio se investigaron las razones por las cuales las tasas de partos domiciliarios continuan siendo altas en las zonas rurales de la Provincia de Shanxi, en China septentrional, a pesar de que existe un programa nacional creado para promover partos hospitalarios. Realizamos entrevistas semiestructuradas con 30 mujeres que tuvieron partos domiciliarios en cinco condados rurales, y obtuvimos datos de auditorias hospitalarias, observaciones y entrevistas con trabajadores de la salud de un estudio mas amplio. Se identificaron multiples barreras, como factores economicos y geograficos y la deficiente calidad de la atencion materna. Las principales razones por las cuales las mujeres no tuvieron partos institucionales fueron dificultades financieras (n=26); calidad deficiente de la atencion antenatal (n= 13); problemas de transporte (n= 11); insatisfaccion con la atencion hospitalaria expresada como miedo de estar en el hospital (n=l0); conveniencia de estar en la casa y continuidad de la atencion brindada por parteras tradicionales (n= 10); y la creencia de que el parto seria normal (n=6). Se deben superar todas estas barreras para poder mejorar la accesibilidad y aceptacion de los partos hospitalarios. Para asegurar una implementacion eficaz de la politica nacional de mejorar la tasa de partos hospitalarios, el gobierno debe mejorar la calidad de la atencion antenatal y durante el parto, aumentar los subsidios financieros para reducir los pagos de las pacientes, eliminar las barreras de transporte y, en las zonas remotas donde el parto hospitalario no es posible, considerar permitir asistencia calificada en la casa, como extension a la comunidad, e integrar a las parteras tradicionales en el sistema de salud., ONE of the indicators for reducing maternal mortality and morbidity of Millennium Development Goal 5 is the rate of skilled birth attendance. Because of it, many developing countries, including China, [...]