Advancing Physiologic Birth Through Midwifery and Community Birth

Abstract

In this column, the associate editor of The Journal of Perinatal Education discusses the importance of advancing physiologic birth through midwifery and community birth by introducing the two featured articles in this issue by Dr. Carol Sakala: Improving Midwifery Care Through Midwifery (Sakala et al., 2021) and Improving Our Maternity Care Now Through Community Birth Centers (Sakala et al., 2022). The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

The story of birth in the United States continues to shock. The maternal mortality rate, the highest in the developed world, continues to rise. In 2020 the maternal mortality rate was 23.8/100,000. The mortality rate for Black women was nearly three times higher than that at 55.3/100,000 (Hoyert, 2022). The cesarean rate continues to rise at 31.8% (Osterman et al., 2022). Infant mortality for Black babies is twice that of White births. Maternity care in the United States is increasingly “intervention intensive” despite ACOG guidelines aimed at reducing cesareans (ACOG, 2014) and unnecessary interventions (ACOG, 2019).

There is compelling research that supports the value of physiologic birth and the risks to mothers and babies of interfering in the physiologic process of labor and birth without clear medical indication. Letting labor start, continue, and end on its own, labor support, freedom of movement, birth in non-supine positions, and keeping mother and baby together support the physiologic process. Routine interventions like induction, augmentation, restrictions on eating and drinking, and epidurals interfere with the physiologic process in powerful ways (Buckley, 2015). The key to reducing maternal and infant mortality and morbidity, for all women, is promoting, protecting, and supporting physiologic birth.

There is compelling research that supports the value of physiologic birth and the risks to mothers and babies of interfering in the physiologic process of labor and birth without clear medical indication.

The National Partnership for Women and Families has done seminal work to address these challenges. This continues the work begun at Childbirth Connection, which became a core program of the National Partnership in 2004. Their work continues to contribute in important ways to our understanding of physiologic birth, to the flaws in the current maternity care system and the changes that need to happen to make birth safer for mothers and babies, and how to advocate for high quality, evidence based, respectful maternity care. A few important examples include “Listening to Mothers III” (Declercq et al., 2013), “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” (Buckley, 2015), and “Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System” (Avery et al., 2018).

We invite readers to respond to the contents of this journal issue or share comments on other topics related to natural, safe, and healthy birth. Responses will be published as a letter to the editor. Please send comments to Wendy Budin, Editor-in-Chief (wendy.budin@rutgers.edu).

Now, under Dr. Carol Sakala’s leadership as Senior Director for Maternal Health, the National Partnership’s maternal health portfolio has published two seminal papers: “Improving Midwifery Care Through Midwifery” (Sakala et al., 2021) and “Improving Our Maternity Care Now Through Community Birth Centers” (Sakala et al., 2022). Together the papers provide evidence in support of midwifery and out of hospital birth as ways to insure the best chance of having a physiologic birth, and in doing so to reduce risk. We are pleased to publish the Executive Summaries of both these publications in this issue of The Journal of Perinatal Education.

The papers tackle head on the connection between maternity care and maternal and infant mortality and morbidity, calling out especially the substantial risks for Black and Indigenous women. The papers provide an excellent overview of the compelling research that supports the value of midwifery and community birth for healthy women with a special emphasis on its value for Black and Indigenous women. Midwives and home and birth centers (with care provided by midwives) are more likely to provide care that promotes, protects and supports physiologic birth. Birth outcomes that are associated with midwifery and community births include lower rates of interventions, increased birth satisfaction, lower cesarean rates, fewer pre-term births, and higher breastfeeding rates.

Midwives and home and birth centers (with care provided by midwives) are more likely to provide care that promotes, protects and supports physiologic birth.

We encourage you to read the full reports. Each report provides an in-depth overview of the research that supports the value of midwifery and community birth in protecting and supporting physiologic birth. This care ultimately makes birth safer for mothers and babies. A major contribution of both papers is an extensive, doable list of recommendations for increasing access to midwifery and community birth settings.

Childbirth education has a vitally important role to play in transforming maternity care and in doing so protect women and their babies from risk.

Childbirth education has a vitally important role to play in transforming maternity care and in doing so protect women and their babies from risk. It is important that we educate women, families, and providers about the safety and improved outcomes of midwifery care and community birth for healthy women. It is just as important to advocate, on a local and national level, for the increased availability of these options.

IN THIS ISSUE

In this issue’s Celebrate Birth column, titled “Walking Between the Raindrops: Evelyn’s Birth Story,” Clara Fajardo takes readers on a journey over the course of three days that resulted in a healthy birth. Her initial concerns over the anticipated tension of an induction and the 20th anniversary of 9/11 dissipate as a baby girl is welcomed as the second child to a Boston-area family.

Also in this issue, Ishak, Petersen, and Quinlivan presented finding from their study that investigated the demographic differences, newborn outcomes, and psychological experiences of English speaking (ES) and non-English speaking (NES) fathers in antenatal and delivery rooms. NES fathers also reported significantly lower elective caesarean surgery rates. However, intrauterine growth restriction was significantly higher amongst the NES newborn cohort. Further, nursery admission of newborns born to NES fathers was more than double that of ES fathers. NES fathers self-reported more psychological symptoms after delivery than ES fathers. This study highlights the dual need for more research into NES perinatal experiences and change in pregnancy management for NES families.

Renece Waller-Wise provides an important update for childbirth educators on umbilical cord blood banking. She argues that to make an informed decision on umbilical cord blood banking or donation during birth, families need evidence-based, quality information on this alternative. Research has shown that expectant parents do not have sufficient understanding of the cord blood banking process, umbilical cord stem cell transplants, uses of these cells, or options. Research also shows that birthing families desire that information to come from a reliable healthcare provider resource, such as a childbirth educator. Therefore, this article offers information for use by childbirth educators, nurses, or other birth workers to increase awareness and knowledge on the topic of umbilical cord blood banking and donation.

Brenda Volling and co-authors describe finding from their longitudinal pilot study designed to assess firstborn children’s reactions to mother-doll interaction and determine if this predicted jealousy of a newborn sibling. These authors speculated that mothers are concerned about their firstborn children’s acceptance of a baby sibling and that by observing children’s reactions to mothers interacting with an infant doll simulator might predict how children will react to the baby sibling. Findings suggest that children respond to mother-doll and mother-sibling interaction differently, with no significant associations across children’s behaviors in mother–doll and mother–sibling interactions. Thus, use of an infant doll simulator before birth did not reliably predict children’s behavioral adjustment after the birth of a baby sibling.

Lastly in this issue, Chinkam, Pierre, Mezwa, Steer-Massaro, and Shorten discuss their pilot study designed to develop and test culturally appropriate group counseling sessions for shared decision making about modes of birth after cesarean for Haitian Creole speakers. The curriculum was created by incorporating information identified by women and their providers in focus groups through the lens of Health Belief Model. As a result of these sessions, there was a 50% increase in women planning to labor after cesarean; nine stated the session gave them confidence to decide about their mode of birth; all were “very satisfied” with the session and would recommend it to others. Authors suggest that this feasible and effective method to improve women’s decision making, could be integrated to improve shared decision-making discussions for other non-English speaking women.

Biography

Judith A. Lothian

Associate Editor

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.