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Meet the New DOR Intern - Katelyn Edel

Posted by Midwives Alliance on February 16th, 2016


Katelyn EdelMy name is Katelyn Edel, and I am the new intern for the Department of Research, where I work closely with Bruce Ackerman, Jen Brown, and Sarita Bennett. 

In addition to my new role with MANA, I am currently a first-year student at the Brown University School of Public Health, where I am focusing on rural health policy and women’s health and working towards my MPH degree. I first contacted MANA because I was looking for a data set that I could use for my upcoming thesis project. I was very committed to the idea of a thesis topic that would not only fulfill Brown’s requirements, but that would also interest and inspire me – and the two most inspiring topics I could think of were midwifery and statistics. 

I have been interested in healthcare for quite awhile, and I have a particular passion for women’s health and their well-being. The intent behind nearly all of my work is to contribute to a world in which women are supported in their reproductive choices, regardless of whether those choices are made at home, in a hospital, or in a larger societal context. I am especially invested in ensuring access, choice, and quality services for women in underserved and low-resource communities, and finding better ways to deliver care to those populations. 

I am incredibly blessed to have grown up in a family that not only supports, but also celebrates, women’s choice. My brother and some of my cousins have been born at home, all with the caring skill that only a midwife can provide. In this sense, I feel that I am really fortunate to have been exposed to midwifery throughout my life, because in school I often find myself in academic or clinical settings where the wisdom of midwifery is not supported, although I look forward to the day that this changes. 

Which, finally, brings me to my enthusiasm and interest in evidence-based practice and research. I firmly believe in the power of data, which is why I think the MANA Statistics Project is so wonderful. MANA Stats is an incredible tool for midwives, for researchers, and for the general community, because it is a vehicle that can provide truly valuable scientific insight. With the DOR, I am helping to ensure that midwives are able to use MANA Stats in an effective way – essentially, I am a “Data Doula,” and I do a lot of Support Calls, Welcome Calls, and general follow-up with the midwives that are enrolled with MANA Stats. I think it’s important to have real, honest-to-goodness phone conversations with the new enrollees, or with contributors who may feel unprepared to use the MANA Stats software, because it creates a sense of community and of support. Long-term, I will be not only continuing my work as a Data Doula but also creating a handbook and other resources for future Data Doulas, which will be important as the MANA Statistics Project continues to grow. 

I’m really very happy to have the opportunity to work with MANA Stats from both ends, as a future researcher using it for my thesis, and as a Data Doula for the midwife-contributors. So far, my work has provided me with a sense of holistic understanding about the entire research process and that has proven to be an invaluable tool. I look forward to continuing my internship throughout the year, and I am especially excited about attending the MANA Conference in Atlanta! Everyday I am inspired by all of the wonderful people that I meet at MANA, and I am honored to be a part of this community. As I continue with school (and as I start the certification process to become a doula!) I hope to be able to contribute to MANA in a myriad of ways – first as an intern, but one day as a member. 

Waterbirth Safe For Babies, Finds New Research

Posted by Midwives Alliance on February 2nd, 2016

Largest Study on Waterbirth Finds No Harm to Babies

New Position Statement Compiles Waterbirth Research for Families, Providers

Many families consider waterbirth, but the 2014 American Congress of Obstetricians and Gynecologists/American Academy of Pediatrics (ACOG/AAP) guidelines recommend against this practice. Fortunately, new information and tools that can inform birthing people’s decision-making process were released in the past week. First, the largest research study in the US on waterbirth was published in the Journal of Midwifery and Women’s Health. Last week, a new position paper compiling the findings of this and other waterbirth research, Midwives Alliance and Citizens for Midwifery Position Statement on Water Immersion During Labor and Birth, was released by Citizens for Midwifery and Midwives Alliance, with the goal of informing families, health care providers, and policy makers. Jeanette McCulloch of BirthSwell interviewed the article researchers Marit L. Bovbjerg PhD, Melissa Cheyney PhD, CPM, LDM and Courtney Everson MA, PhD and position paper authors Nasima Pfaffl MA, Jill Breen CPM, CLC and Justine Clegg MS, LM, CPM, to help inform childbirth educators and others on how to interpret the findings and the position paper for their clients. 

Jeanette McCulloch: What were the key findings of the research?

Marit Bovbjerg PhD: We found that being born underwater did not confer any excess risk to the baby. Babies born underwater were no more likely than those not born in water to have a low five-minute Apgar score, or require hospitalization or neonatal intensive care (NICU) admission. We also found no evidence that waterbirth is associated with neonatal death; on the contrary, in our sample of 6,534 babies born in water, there were no cases of death that could be attributed to being born in water. This indicates that, for low-risk mothers whose labors proceed normally, water immersion is generally a safe pain management option.

For the pregnant parent, we found that waterbirth was not associated with infection or hospitalization. Surprisingly, though, we found that mothers in the waterbirth group were slightly (11%) more likely to experience perineal tearing.  This finding is contrary to numerous previously-published studies, most of which reported a lower rate of tearing in mothers choosing waterbirth. The question of trauma (tearing), then, is still unresolved, and any future studies on waterbirth should make this outcome a focus.

However, even if the small, but increased risk of tearing that we reported is replicated in other studies, many individuals may still choose to labor and birth in water for the labor pain relief described in numerous other studies. For those who want to avoid epidurals and other drugs, spending a portion of active labor in a pool or tub may facilitate an unmedicated physiologic birth with all the benefits we know that confers for both mother and baby (ACNM, MANA, and NACPM, 2012; Buckley, 2014)1  Each childbearing family should weigh the potential benefits (reduction of labor pain) and the potential risks (possible increased risk of tearing), and decide based on their own values and preferences. The main upside of our research is that clients can explore these issues without worrying about whether or not waterbirth will negatively affect their babies. It won’t.

JMc: This research was based on home and birth center births from the MANA Stats dataset.   Are the outcomes applicable to the hospital setting?

Melissa Cheyney PhD, CPM, LDM: As Marit just highlighted, our findings suggest that waterbirth is a reasonably safe option for use in low-risk, low-intervention births, especially when the risks associated with other forms of pharmacologic pain management, like epidural and spinal anesthesia, are considered. Because hospitals that do allow waterbirths generally only provide this option to low-risk women, we believe these results could be applied in other settings. We know that there are several hospitals here in Oregon, for example, that have active waterbirth programs and are currently tracking their outcomes. Their preliminary impressions are that babies born in water are at no greater risk, and that water immersion as a pain management strategy helps to decrease rates of epidural use.  

It is possible that training and experience level of the provider makes a difference in outcomes. In our sample (based on MANA Stats) 35 percent of births occurred under water. This means that many of the midwives who contribute data to MANA Stats are very experienced at monitoring and attending births in the water. While some hospitals do offer waterbirth programs, it is currently unclear how frequently births happen under water in these facilities. One difference between the provider populations represented in our study, who are almost all CPMs and CNM/CMs, and those who might attend waterbirths in the hospital could be variability in exposure to, and experience with, labor and delivery management in the water. 

That said, when we look at the balance of evidence from international studies, our study, and preliminary data from hospitals in the US, we believe that findings are converging around the sentiment that while waterbirth may not confer any particular safety benefit for babies, it almost certainly confers no added risk to the neonate in low-risk pregnancies. Families should be allowed to choose waterbirth from among a range of pain management options. We would like to see waterbirth offered more widely across the US in all birth settings. 

JMc: The MANA and CfM Position Statement on Water Immersion During Labor and Birth brings together peer reviewed evidence and the clinical experience of midwives who provide waterbirth. How can childbirth educators use this document to support clients considering waterbirth?         

Justine Clegg MS, LM, CPM: Because laboring and birthing in water is popular with clients, especially those choosing to birth at home and in birth centers, childbirth educators, doulas, midwives and midwifery educators need to be well versed in the issue to answer consumer questions, and provide the most current information to help families decide what is best for them. 

The Position Paper is a great educational tool that gives concise access to the research and the wisdom of experience that documents the safety, benefits, and recommendations for success. 

Jill Breen CPM, CLC: First, I think the research we cite will help to dispel some of the publicized concerns (drowning, cord avulsion, respiratory distress) about safety to the baby since no deaths in over 6500 waterbirths were attributable to being in the water.  

The position paper also makes it clear that the experience level of the practitioner may be an important factor in the safety of waterbirth. Childbirth educators can help clients identify experienced practitioners in their area or help families develop questions that they can ask to choose a site and practitioner for their planned waterbirth. 

In the position paper, Jennie Joseph LM, CPM identifies another potential outcome important to raise with some clients. Because waterbirth may reduce stress and promote physiologic birth, thereby reducing the likelihood of unnecessary procedures and disruptions of the newborn transition and parent/infant attachment, access to waterbirth may be an important tool to address disparities in outcomes for families of color.

JMc: What role should consumer choice and shared decision making play in waterbirth? 

Nasima Pfaffl MA: Just as in all birth choices, shared decision making is key. 

One of the primary tenants of the Midwives Model of Care is individualized counseling and education. For all birthing decisions, a midwife and the birthing family can explore the available evidence, the client’s needs, values and preferences, and the midwives experience, comfort level and clinical recommendations during shared decision making.

For example, let’s look at the conflicting findings across all waterbirth literature for vaginal tearing. The small increased risk of perineal trauma could be a deciding factor for some clients, but a small concern for those who place greater emphasis on the research findings that show overall high rates of satisfaction with waterbirth. The warmth, mobility, comfort, privacy and pain relieving attributes of laboring and birthing in water may be a deciding factor for others. 

For families who  want a waterbirth, I recommend when possible, choosing a practitioner with a high degree of comfort, knowledge, and experience with waterbirth. A knowledgeable practitioner will be familiar and comfortable with the differences between water and air birth (such as evaluating blood loss in water) and should be able to discuss these with their client. 

JMc: How do findings from the recently released paper on waterbirth compare to the current ACOG/AAP guidelines?

Courtney Everson MA, PhD: The ACOG/AAP guidelines (Committee Opinion No. 594), released in April 2014, were a primary impetus for this study. In those guidelines, ACOG and AAP acknowledge the safety and potential benefits (i.e., pain management) of laboring in water, but also state that the safety of birthing in water has not yet been established and, thus, waterbirth is not recommended.  

At the time the guidelines were written, many small- to medium-sized cohort studies from Europe were published suggesting that waterbirth was safe. However, the ACOG/AAP guidelines did not include this evidence, and cited instead primarily case series and case reports. Case series/reports are not studies; rather, they are a description of what happened to a few patients (laboring women/newborns, in this scenario). There is no comparison group and the results are based on a very small sample, which means that robust conclusions about the exposure (in this scenario, waterbirth) cannot be drawn. Knowing, for example, that one baby ended up in the NICU from the case group of 10 waterbirths is not helpful unless you also know how many babies went to the NICU from a similar group of non-waterbirths.  

In the guidelines, ACOG and AAP recognize the limitations of available research, stating, “Before examining available evidence concerning immersion during childbirth, it is important to recognize limitations of studies and evidence in this area” (ACOG/AAP, 2014, 1). We believe that our research has addressed these limitations, and now offers good evidence for the safety of waterbirth. 

Our sample of 6,521 women (6,534 neonates), with a comparison group of 10,252 women (10,290 neonates) who did not choose waterbirth, makes this the largest study on waterbirth to-date. Additionally, this is the first large waterbirth study in a US population, which is important because of the acknowledged uniqueness of both the US healthcare system and the US population. 

With this publication, there is now a study in a US population examining neonatal and maternal outcomes for more than 6500 waterbirths. Contrary to conclusions drawn in the ACOG/AAP guidelines, findings from this study demonstrate that waterbirth confers no additional risk for babies. Future position statements and clinical guidelines should reflect the balance of evidence on waterbirth to-date, which suggests that birth in the water is a safe and viable option for low-risk pregnancies and, accordingly, should be offered as an option to childbearing families. 

1ACNM, MANA, NACPM. (2012). Supporting healthy and normal physiologic childbirth: A consensus statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives. Journal of Midwifery & Women’s Health, 57(5), 529–532.

Buckley, S. (2015). Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women & Families.

Photo credit: Megan Hannon Photography courtesy Izabella de Barbaro

About the authors

Marit BovbjergMarit Bovbjerg PhD, MS is a reproductive and health services epidemiologist at Oregon State University. Dr. Bovbjerg's research focuses on maternity care in the US, with a sideline into physical activity during pregnancy/postpartum. In her non-work time, she likes to knit, grow vegetables, cook, and play outside (hiking, running, biking, etc.) She does not like to sit still and in fact avoids doing so whenever possible. Marit and her husband are attempting to turn three exuberant children into responsible adults, a task at which they might, on a good day, be slowly succeeding (though likely through no fault of their own). They live in an untidy but cheerfully-painted house in rural Oregon, and enjoy vacationing in places with abundant outdoor activities but few people.

Jill Breen

Jill Breen CPM, CLC has been serving women, babies and families for 37 years as a homebirth midwife and natural family health consultant. A MANA member since 1984, Jill has served on the Board of Directors in several positions including President, as well as on several working committees, and currently is Communications Chair. She is a founding member of Midwives of Maine, a statewide, inclusive association of midwives since 1981. Jill is a Home Birth Summit delegate active on the Collaboration Task Force. She was an appointee to the Maine Governor’s Advisory Committee on Rulemaking regarding certified midwives and was a member of the Maine CDC Inter-professional Work Group addressing flow of care across birth settings. The Maine Best Practice Recommendations for Handoff Communication During Transport from a Home or Freestanding Birth Center to a Hospital Setting was approved by the Commissioner of Health and Human Services in November, 2014. Jill writes, speaks, and mentors including as a guest lecturer at University of Maine. She is the mother of 6 children, all born at home, and has 9 grandchildren, all born into the hands of midwives, including her own.

Missy CheneyMelissa Cheyney PhD, CPM, LDM is Associate Professor of Clinical Medical Anthropology at Oregon State University (OSU) with additional appointments in Public Health and Women’s Studies. 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. She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) along with several, peer-reviewed articles that examine the cultural beliefs and clinical outcomes associated with midwife-led birth at home. Dr. Cheyney is an award-winning teacher and was recently given Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the MANA Statistics Project. She is the mother of a daughter born at home on International Day of the Midwife in 2009.

Justine CleggJustine Clegg MS, LM, CPM is a Florida Licensed Midwife, Licensed Mental Health Counselor, and Certified Lactation Counselor with over 35 years experience in maternal-child healthcare, homebirth and education. She lives in Miami, FL and Asheville, NC with husband Jim Brinkman. She is currently AME Board secretary, and most recently Academic Director for Commonsense Childbirth School of Midwifery in FL. As Midwives Association of Florida “founding mother” (1979) Justine helped write and pass Florida’s midwifery licensing law, start the South Florida School of Midwifery, and was Administrative Director in the 1980s. She established a 3 year midwifery degree program at Miami Dade Community College, served as Midwifery Chair and Professor 1993-2008, and earned an Endowed Chair (2003). As Council of Licensed Midwifery Chair from 1993-2001, she helped write Florida’s midwifery practice rules. She is on Miami-Dade County Fetal and Infant Mortality Review’s team since 1997, and FIMR Chair, 2004-2008. A former Board member of MEAC and NACPM, she helped create NARM’s certification program in the 1990s. As Midwives Association of Florida CEU coordinator, she helps host MAF’s state conferences every two years. As a member of the North Carolina Midwives Alliance, Justine was MANA Region 3 conference CEU coordinator August 2011 in Cary, NC, and supports the initiative to legalize CPMs in North Carolina. She is the Midwives Alliance Documents Chair. Her 3 children and 6 grandchildren make her a “granny midwife.”

Courtney Everson

Courtney L. Everson MA, PhD is a Medical Anthropologist and the Dean of Graduate Studies at the Midwives College of Utah, Salt Lake City, UT. Dr. Everson is also the Director of Research Education for the Midwives Alliance of North America (MANA) Division of Research (DOR); Co-founder and Vice President of the Oregon Doula Association (ODA); a Research Working Group (RWG) member of the Academic Collaborative for Integrative Health (ACIH); an Accreditation Review Committee (ARC) member for the Midwifery Education Accreditation Council (MEAC); and serves on the Boards of Directors for the Australasian Professional Doula Regulatory Association (APDRA), the Oregon Doula Connection, the Association of Midwifery Educators (AME), and the Academic Collaborative for Integrative Health (ACIH). Dr. Everson's research and teaching specializations include: maternal-child health; human childbirth; adolescent pregnancy and parenting; psychosocial stress; social support; doula care; midwifery care; research and clinical ethics; evidence-informed practice; collaborative care models; mixed methodologies; health inequities; cultural competency/humility; social justice; and underserved populations. She actively publishes in academic forums, and is an invited, avid speaker at local, national and international venues.

Jeanette McCullochJeanette McCulloch BA, IBCLC has been combining strategic communications and women’s health advocacy for more than 20 years. Jeanette is a co-founder of BirthSwell, helping birth and breastfeeding organizations, professionals, and advocates use digital tools and social media strategy to improve infant and maternal health. She provides strategic communications consulting for state, national, and international birth and breastfeeding organizations. A board member of Citizens for Midwifery, she is passionate about consumers being actively involved in health care policy.

Nasime Pfaffl

Nasima Pfaffl MA is a medical sociologist with a focus on social movements and women’s health. She is a second generation home birth mom. She is the current president of Citizens for Midwifery and has served on the board since 2006. She worked for the Midwifery Education Accreditation Council as their Accreditation Coordinator. She served on the MAMA Campaign steering committee, on the Birth Network National Board, the Coalition for Improving Maternity Services Leadership Team (Board), and as the Grassroots Advocates Committee Co-Chair and Survey Team Lead for The Birth Survey. Nasima focuses on coalition building and utilizing capacity building technologies and tools to make midwifery advocacy organizations stronger, more effective and able to create the change needed in our broken maternity care system. She lives in Florida with her son, daughters and husband. Nasima can be reached by email.


MANA and CfM release new Joint Position Statement on Waterbirth

Posted by Midwives Alliance on January 28th, 2016

Mother and baby in birthing tub

The MANA and CfM Joint Position Statement on Water Immersion During Labor and Birth is a position paper written for a broad audience including midwives and other birthcare professionals, consumers, doulas, childbirth educators, and policy makers. It is co-authored by the Midwives Alliance of North America and Citizens for Midwifery. A year of collaborative work has produced a great educational tool that gives concise access to the research and the wisdom of experience that documents the safety, benefits and recommendations for success. With over 80 citations, including the new study "Maternal & Newborn Outcomes Following Immersion During Waterbirth" by Bovbjerg, Cheyney and Everson, which utilized data from the MANA Statistics project, and research by waterbirth activist Barbara Harper, the position paper is a reference guide to the evidence for the safety of water immersion during labor and birth.

How does the new study using data from the MANA Statistics project help us better understand waterbirth?

The research of Bovbjerg, Cheyney and Everson helps to dispel some of the more publicized concerns about the safety of waterbirth to the baby, including drowning, cord avulsion and respiratory distress. No deaths in over 6500 water births were attributable to being born under water. There was also no additional risk of maternal infection or hemorrhage.

The MANA Stats study showed that 35% of over 18,000 home and birth center births occurred in water, demonstrating that the midwives contributing to MANA Stats have considerable experience attending and monitoring births in water. The experience level of the practitioner may be an important factor in the safety of waterbirth.

6,521 waterbirths, including 13 sets of twins, 29 breeches and 327 VBACs, were compared with 10,252 mothers who did not choose waterbirth, making this the largest comparative study on waterbirth to-date. Additionally, this is the first large waterbirth study of a US population, with its unique healthcare system and demographics.

While the ACOG/AAP Committee Opinion of April, 2014, not recommending water immersion for birth, acknowledged the limitations of the available research on waterbirth, this large US study fills that gap and gives us the best evidence to-date on the safety of birthing in water.

"Maternal & Newborn Outcomes Following Immersion During Waterbirth" by Bovbjerg et al, was published Jan. 20, 2016 in the Journal of Midwifery & Women's Health. JMWH has generously agreed to make this research article open access, so midwives, birth workers, and consumers can read it without needing to buy a subscription to the Journal.

What else can we learn from the MANA/CfM Joint Position Statement?

Evidence and experience show us that mothers choose waterbirth for several reasons. They report feeling more relaxed, in control, able to move more freely, and, notably, relief from pain. Especially considering the risks of pharmacologic pain management such as epidural and spinal anesthesia, water immersion during labor and birth may be safer for mother and baby. "In addition, because water immersion facilitates normal physiologic birth it may also be associated with other beneficial health outcomes for mother and baby, including decreased need for intervention during labor and reduced incidence of surgical/instrumental delivery." (quote from the statement)

As in all healthcare and birthcare decisions informed consent/refusal and shared decision making with your care provider is key to determining what is best for each family. The Joint Position Statement can help in these ways:

  • describes the benefits of water immersion for mother and baby,
  • suggests how these benefits may improve outcomes for families of color,
  • addresses consumer choice and shared decision making,
  • considers client values and individual needs and,
  • lists factors that promote safety and success.

The practical and professional pearls of wisdom make the Factors that Promote Safety and Success section an invaluable tool when considering and planning a waterbirth and we are pleased to be able to share them with you.

The conclusion: Many families consider water immersion during labor and birth a valuable option. Current research and experience show waterbirth to be safe for mothers and babies and may provide benefits to both. "MANA and CfM support the use of water immersion during labor and birth, and believe it should be made available to birthing families across all settings. MANA and CfM encourage all care providers to become educated about the safe use of water immersion during labor and birth, and to engage in a shared decision making process when discussing the option of water immersion with their clients." (quote from the statement)

The authors of the joint position statement are:

Jill Breen, CPM, CLC; Justine Clegg, CPM, LM, MS; Nasima Pfaffl, MA, President CfM; Amy Smith, CPM

Thanks also to the consultants on the statement: 

Barbara Harper, RN, CD, CCE; Holly Horan, MA; Jennie Joseph, LM, CPM, CEO of Commonsense Childbirth, Inc.; Indra Lusero, JD, MA; Jeanette McCulloch, IBCLC; Shafia M. Monroe, MPH, DEM, CDT, President and CEO of the International Center for Traditional Childbearing (ICTC).

About the author

Jill Breen, CPM, CLC, has been serving women, babies and families for 37 years as a homebirth midwife and natural family health consultant in central Maine. She has 6 children and 9 grandchildren, all born into the hands of midwives including her own. She has served MANA in several capacities, including as President, and is currently Communications Chair. She is a member of the Home Birth Summit Collaboration Taskforce.

Meet Nicole, MANA Director of Events

Posted by Midwives Alliance on January 20th, 2016

Nicole Marie White

Hello MANA members and friends,

I am your Director of Events, Nicole Marie White, CPM. I am from Michigan and currently working as a member of the Coalition to License Certified Professional Midwives in Michigan. We just passed the house in December!

My great great grandma was a midwife.

Her name was Fannie Bush. I didn't know about her until after I began attending births in 2001. I took the long road apprenticing with several midwives in different practices and finally I attended Maternidad La Luz for the year program. I am so glad I did. I was surprised at how much I loved the clinic setting, collaborating with other midwives and getting to provide access of care to many more people then I was accustomed to in the home birth setting. I started my studies in San Francisco, CA and was able to participate in an awesome program at St. Elizabeth's where we did labor support and child birth education for the teenage mothers who resided there. After 10 months, I gained an apprenticeship in Santa Cruz. I know both of those experiences colored my understanding of midwifery care and the impact that quality maternity care has on every mother and baby. I just finished a 2 year stint working in a bustling, adorable home birth practice in Traverse City, MI. Prior to that I had a fellowship in the city of Detroit to work towards lowering the infant mortality in the city. I also have spent time working as a midwife in Uganda and Haiti.

I’m thrilled to be on the MANA board.

"Midwives are the warriors on the front line of health care battling to ensure that women survive childbirth and babies are born safely even in the most marginalized areas." (World Health Organization) My interest in spreading the midwifery model of care is what fuels me. I truly believe midwives are the answer to much of the maternal health crisis we see here in the US and abroad. I look forward to when the CPM is recognized and licensed all over the USA.

What do I do at MANA?

I am Director of Events, so that means I am at the helm of our fabulous Annual Conference!

Conference is such a corner stone to MANA and I am honored to be part of the amazing team that makes it happen. SHINE was such a bright way to begin my MANA journey and this year in Atlanta will prove to be another fantastic time. Conference is so important and many people look forward to it every year. Time to connect, celebrate, learn, see old friends and make new ones. Midwives are such a unique group! We are all different but share a common, deep thread. I loved when Deborah Kaley accepted her MANA educator award in Albuquerque and she said all her friends are midwives, former midwives, current midwives or future midwives. It made me smile and be grateful to be in a room full of friends.

Please reach out to me if you want to be more involved, have questions or suggestions, this is your conference! As MANA is your organization this is your conference! Thank you for doing this work. I am in deep appreciation for all of you that have worked so hard to create this solid foundation.

I am currently in the airport in Paris on my way to Greece. I am headed to Greece to work with Circle of Health International ( COHI ) in the refugee camps. Please check them out for more info! And check my website if you want to get to know me better. Thank you for welcoming me into the folds of such a rich, important organization.

See you in October at MANA16 in Atlanta, Georgia!

~ Nicole

New and Sometimes Conflicting Research on Out-of-Hospital Birth

Posted by Midwives Alliance on January 7th, 2016

In the past month, two new studies have been released - one in the New England Journal of Medicine (NEJM), the other in the Canadian Medical Association Journal (CMAJ) - examining out-of-hospital birth outcomes. The CMAJ study examined 2006-09 provincial health records while the NEJM study analyzed two years of Oregon vital statistics data. What makes the NEJM study unique is that the Oregon birth certificate now allows researchers and others to track the intended place of birth, providing for more accurate categorization of the outcome of transfers.

The two studies both found that families that choose out-of-hospital birth experience fewer interventions, including labor augmentation, assisted vaginal births, cesarean births, and episiotomies.

Both studies also found that the absolute risk of adverse neonatal outcomes is small regardless of setting. However, the CMAJ study found equivalent risk between home and hospital settings, while the NEJM study found that planned out-of-hospital births were associated with an excess of less than 1 fetal death per 1000 deliveries -- a small but statistically significant difference. 


Media coverage. MANA has compiled resources for midwives reviewing the outcomes and providing guidance for interpretation for families. 

First, here's a piece in Forbes that provides balanced coverage (note the article - like many - refers to "home birth" while the study combined birth center and home birth data together). 

MANA provided expert commentary to a number of the recent news articles, including The New York Times and The Washington Post.

Expanded coverage at Science and Sensibility. The official blog of Lamaze International has provided balanced coverage of the New England Journal of Medicine research. In this post, Henci Goer compares and contrasts this newest study with other recent home birth analyses. Missy Cheyney, Chair of the Midwives Alliance Division of Research, provides guidance for families interpreting the new research in this post.

Model transfer guidelines. The authors of the NEJM article call for increased collaboration and integration of out-of-hospital providers into the maternal health care system. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital, developed by the collaboration committee of the Home Birth Summit, are an important and practical tool to increase integration.

The guidelines were designed to facilitate the safe and mutually respectful transfer of care of a woman and her family from a planned home birth to the hospital. The model blueprint was created as the result of a unique collaboration among physicians, midwives, nurses and consumers.

To learn more or endorse the guidelines, visit here.