Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive author...

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Published in:PloS one Vol. 13; no. 2; p. e0192523
Main Authors: Vedam, Saraswathi, Stoll, Kathrin, MacDorman, Marian, Declercq, Eugene, Cramer, Renee, Cheyney, Melissa, Fisher, Timothy, Butt, Emma, Yang, Y. Tony, Powell Kennedy, Holly
Format: Journal Article
Language:English
Published: United States Public Library of Science 21.02.2018
Public Library of Science (PLoS)
Subjects:
Autonomy
Biology and Life Sciences
Birth weight
Breast feeding
Breastfeeding & lactation
Childbirth & labor
Childrens health
Collaboration
Correlation analysis
Correlation coefficient
Correlation coefficients
Female
Health care industry
Health Services Accessibility
Healthcare Disparities
Home births
Humans
Infants
Integration
Internet
Jurisdiction
Low birth weight
Maternal & child health
Maternal child nursing
Maternal Health Services - organization & administration
Medical personnel
Medicine
Medicine and Health Sciences
Midwifery
Midwives
Neonates
Newborn babies
North Carolina
Nurse Midwives
People and Places
Practice
Pregnancy
Pregnancy Outcome
Premature birth
Regional analysis
Regression analysis
Regulation
State regulations
Statistical analysis
United States
Vagina
Vital statistics
Washington
Womens health
United States
Oregon
Canada
Vancouver British Columbia Canada
United States > US
Maryland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the 'on the ground' relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0192523