Photo by Mr Cup / Fabien Barral

Midwifery Today, Issue 145, Spring 2023.
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Lawmakers Promise Legislation to Aid Mothers and Babies

The national stillbirth rate for the US in 2020 was 5.74 per 1000 live births, ranking among the highest in the world. Black mothers are three times as likely as white mothers to experience a stillbirth. As many as one in four of these babies could have been saved with early intervention and healthcare equality. ProPublica reports that lawmakers are putting forward the “Momnibus” bill, which aims to reduce maternal mortality and health care inequity, as well as provide additional funding for stillbirth prevention, research, and data.

• Eldeib, Duaa. 2023. “Lawmakers Pledge to Fight for Comprehensive Action on Stillbirths.” ProPublica. www.propublica.org/article/lawmakers-pledge-to-fight-for-comprehensive-action-stillbirths.

Smoking During Pregnancy Has Declined in the US

According to a study by the CDC, smoking while pregnant has declined by more than a third between 2016 and 2021, including a 16% decline from 2020 to 2021 alone. These improvements are seen throughout age, race, and geographical groups. It is well established that smoking during pregnancy is a risk factor for pregnancy complications and adverse health outcomes for newborns. Although the data for this study was obtained from birth certificates and smoking during pregnancy is self-reported by mothers, the numbers are encouraging.

• Martin, JA, MJK Osterman, and AK Driscoll. 2023. “Declines in cigarette smoking during pregnancy in the United States, 2016–2021.” NCHS Data Brief, no 458. Hyattsville, Maryland: National Center for Health Statistics. doi: https://dx.doi.org/10.15620/cdc:123360.

Homebirths Have Increased in the US

The National Vital Statistics System reported a 12% increase in homebirths for all women for the period 2020 to 2021, the highest rate since 1990. A previous report indicated a 22% increase from 2019 to 2020, at the beginning of the pandemic. For the years 2019 through 2021, there were 135,794 recorded homebirths in the US. There were significant increases in more than half the states in the country. The increase in homebirth statistics coincided with the first two years of the Covid-19 pandemic, when hospitals were overwhelmed, and pandemic restrictions limited who could accompany laboring women. This adds to our understanding of the effect Covid-19 had on health care choices and decisions. It also indicates that homebirth is becoming a viable choice for more families and that midwives are needed now more than ever.

• Gregory, ECW, MJK Osterman, and CP Valenzuela. 2021. NVSR 70-15: “Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother: United States, 2018-2019 and 2019-2020.” National Center for Health Statistics (US). www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20221117.htm.

Second-Stage Water Immersion Proves Beneficial for Mom and Baby

Using health record data from 2014 to 2018 from eight hospitals, researchers compared birth outcomes between woman intending to have hospital waterbirths with those birthing on land. Comparison cases were matched 1:1 using propensity scores. The researchers found that immersion in water during second-stage labor resulted in significantly fewer NICU or special-care nursery admissions and fewer perineal lacerations than the group without immersion. ACOG and AAP have previously stated that water immersion during the first-stage of labor can safely provide pain relief, reduced use of analgesics, and shorter labors, but data regarding second-stage safety and benefits was lacking. This study adds to the growing body of knowledge that midwives and moms have known for decades; waterbirth is safe and the benefits for mothers and babies are great.

• Sidebottom, AC, et al. 2020. “Maternal and Neonatal Outcomes in Hospital-Based Deliveries with Water Immersion.” Obstet Gynecol 136(4): 707–15. https://journals.lww.com/greenjournal/Fulltext/2020/10000/Maternal_and_Neonatal_Outcomes_in_Hospital_Based.11.aspx.

Hot Compresses After Birth Benefit Mothers

According to Chinese Medicine, keeping the mother warm after birth is essential for her health and recovery. Re-establishing Qi, protecting from external pathogens, restoring blood volume and energy are aided by applying targeted heat and keeping the mother warm overall. In a randomized clinical trial involving 1200 postpartum mothers in China, applying hot compresses over the belly button, sacrum, and soles of the feet resulted in a significant decrease in postpartum urinary retention, uterine contraction pain, and depressive symptoms, and an increase in breastmilk production. Hot compresses are a non-invasive way to make the mother more comfortable and hasten her recovery after birth. Midwives and doulas know this method is beneficial and, perhaps, it will become a more common practice in medical settings after studies such as this.

• Zhu, Y, et al. 2022. “Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery. A Randomized Clinical Trial. JAMA Netw Open 5(5): e2213261. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2792535.

WHO Update on Worldwide Maternal Mortality

According to the World Health Organization (WHO), the global maternal mortality rate fell by 33% from 2000 to 2015. However, in the years since 2015, maternal mortality has barely declined. Despite global commitments made in 2000 to reduce preventable maternal mortality, efforts around the world are failing. WHO has issued a statement reaffirming the goals set out in the 2015 Sustainable Development Goal to reduce the global maternal mortality rate to less than 70 maternal deaths per 100,000 live births by 2030.

• WHO. 2023. “Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division.” www.who.int/publications/i/item/9789240068759.