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Practice Updates for Midwives

2011 Clinical Update: Gestational Diabetes Testing and Management

A summary of the most recent research and Guidelines on Gestational Diabetes compiled by MAWS member Kristin Effland, LM, CPM. This compilation of data was originally presented at the 2010 MANA (Midwives Alliance of North America) Conference but was also updated in September 2011.

Click here for this 2011 Clinical Update on GDM Testing and Management.

Newborn Hearing Screening

Why screen for hearing loss? Only approximately 50% of hearing loss in children is traceable to risk factors such as family history of hearing loss, illness during pregnancy or birth complications. By not screening we miss 50% of all hearing impaired children.

Click here for a full discussion from the Washington DOH and a handout that can be shared with parents.

Substance Abuse Screening in Pregnancy

Substance abuse during pregnancy has been identified as an issue critical to the health of mothers and babies from all socioeconomic groups. It is estimated that in Washington State, between 8,000 and 10,000 infants born each year are exposed prenatally to illegal drugs or alcohol.

Click here for the revised screening guidelines document from the WA DOH. (PDF)

Managing Hepatitis B positive mothers and out of hospital birth

Hepatitis B virus (HBV) infection in a pregnant woman poses a serious risk to her infant at birth. Without postexposure immunoprophylaxis, approximately 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection. Of that 40%, approximately one-fourth will eventually die from chronic liver disease or liver cancer.

Click here for a full discussion of the subject and additional resources.

Charting Presentation by Karen Hays

In 2011, Karen Hays, CNM, PhD presented at the MAWS Spring Conference on the topic of Charting for Midwives. She focuses on the differences between charting as a nurse vs. charting as an autonomous care provider. She provides specific examples and makes recommendations for improving the chart forms that many MAWS members use that were developed by MAWS several years ago. Her presentation is here in two documents:

Charting Presentation (PDF)
Charting Examples (PDF)

Air versus oxygen for resuscitation of infants at birth

About 5 to 10% of infants need resuscitation at birth. Many experts recommend that these babies be resuscitated with 100% oxygen, but other experts think that normal room air is as good as or better than 100% oxygen. Too much oxygen can make breathing difficult for babies and can cause other problems such as problems with brain development, an eye condition (retinopathy of prematurity), and a lung condition (bronchopulmonary dysplasia). The authors of this Cochrane review questioned whether resuscitation with room air resulted in fewer deaths or disabilities than 100% oxygen. After searching the literature, they found five studies. There were a total of 1302 infants in these studies; 24% of them were premature. In the studies, fewer babies died when resuscitated with room air than with 100% oxygen. Many of the babies resuscitated with room air also got some oxygen as a supplement, making it difficult to compare the two groups. There were also other problems with the way the studies were carried out. The authors of the Cochrane review concluded that there is not enough evidence to recommend room air over 100% oxygen, or vice versa.

Cochrane Review Abstract

2010 CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Revised Guidelines for the Prevention of Perinatal Group B Streptococcal (GBS) Disease were published in the Morbidity and Mortality Weekly Report (MMWR) on November 19, 2010. These 2010 guidelines were developed using an evidence-based approach in collaboration with several professional associations. They received formal endorsements from:

2010 CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Special Report—Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

This special report was published in Pediatrics Volume 126, Number 5, November 19, 2010. They write that the "guidelines are an interpretation of the evidence presented in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations1). They apply primarily to newly born infants undergoing transition from intrauterine to extrauterine life, but the recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. For the purposes of these guidelines, the terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to an infant at the time of birth. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures."

Full article available through HEAL-WA to LMs and other WA Health Care Providers as an EJOURNAL.

Cord Blood Banking Research and Resources to Inform Shared Decision-Making Discussions with Clients

Cochrane Review on the Benefits and Risks of Delayed Cord Clamping

American Academy of Pediatrics (AAP) Policy Statement on Cord Blood Banking for Potential Future Transplantation

Video by Penny Simkin on the Benefits of Delayed Cord Clamping

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