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Practice Updates for Midwives


RCOG/RCM statement on umbilical cord blood collection and banking

(Joint Statement between UK Royal College of Midwives and Royal College of Obstetricians and Gynaecologists) August 2011. To read statement click here (PDF)

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New Cervical Cancer Screening Recommendations (March 2012) from the USPSTF & the ACS

In March 2012, the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) released final versions of their new recommendations on screening for cervical cancer. Although there were some differences in the draft recommendations of these two organizations, final guidelines are in agreement on these points:

  • Women should begin cervical cancer screening at age 21.
  • Women of average risk between the ages of 21 and 65 should have a Pap smear every 3 years or, for women 30 to 65, a Pap test and an HPV test every 5 years.
  • Women over the age of 65 should discontinue screening if prior regular screenings have been normal and they are not at high risk for cervical cancer.

For the ACS, this represents a change from their previous recommendation that women be screened for cervical cancer with an annual Pap smear. Both organizations highlight in their recommendations that HPV testing should not be performed alone (without a Pap smear) and not in women under age 30 unless, the ACS states, a woman has an abnormal Pap test result. READ MORE

For another reference on this topic, consider the ASCCP Guidelines:
The 2006 Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests were published in the American Journal of Obstetrics and Gynecology (2007;197(4):346-355). To read the guidelines as published in AJOG, click here (PDF).

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ACOG (American Congress of Obstetricians and Gynecologists) Committee Opinions

For a complete list of ACOG Committee Opinions, click here

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2012 AAP Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease

In January 2012, the Ameican Academy of Pediatrics (AAP) Journal Pediatrics published a Policy Statement announcing their Endorsement of Health and Human Services Recommendation for Pulse Oximetry Screening for Critical Congenital Heart Disease. An earlier article in Pediatrics in Nov 2011 reports on Strategies for Implementing Screening for Critical Congenital Heart Disease. For more information from the CDC about Screening for Critical Congenital Heart Defects, click here.

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Doctors Opposing Circumcision Response to New AAP Statement on Circumcision

"It is clear that the members of the [AAP] task force were chosen with a view to obtaining an outcome favorable for the continued practice of circumcision of male children and to provide for third-party payment to doctors.'The task force was augmented by representatives from the American College of Obstetricians and Gynecologists, and one the American Academy of Family Physicians, representing the two trade associations, other than the AAP, which profit most from performing medically unnecessary non-therapeutic circumcisions on children. Those trade associations are called 'stakeholders'(p. 585 and p. e756). Stakeholders are people with a financial interest in an enterprise. When all charges are considered, medically unnecessary, non-therapeutic circumcision produces more than $1.25 billion in income annually for the stakeholders.

It appears that no member of the task force had a foreskin. The task force asserts that current evidence that the health benefits of male circumcision outweigh the risks, but has failed to produce any sort of analysis to support that conclusion. Previously available cost-benefit studies do not support that conclusion. READ MORE

New AAP statement on Newborn Male Circumcision (Aug 2012)

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Flu Vaccine in Pregnancy: Recommendations and Resources

Many pregnant clients have quite a few questions about the flu vaccine especially during flu season and probably also because the 9a combination shot that provides protection against H1N1 and seasonal flu is also available this 2012-2013 season.

Whether to vaccinate during pregnancy can be a tough decision to make. And, some employers, particularly in the health professions, are strict about their employees getting vaccinated for flu.

Here are some resources for midwives and their clients:

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Whooping Cough Reaching Epidemic Levels: Avoid Putting your Clients at Risk

Click below for more information about:

The Department of Health recommends the Tdap booster vaccine "for everyone who will have contact with new infants, especially pregnant women, family members, and health care workers."

Vaccine Information: The WA state Department of Health reports that a pertussis-only vaccine is not available. Pertussis is included in the TDap adult vaccine which is considered a lifetime booster and does not contain thimeresol. Licensed Midwives cannot administer the vaccine but are encouraged to advise clients to request the vaccine from their PCP or to have them call their local pharmacy and inquire about receiving it there. The DOH does not currently have vaccine clinics.

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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.

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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.

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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)

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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.

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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)

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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

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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.

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Guidelines & Research on the Prevention of Perinatal Group B Streptococcal Disease

Cochrane Review of the Research on the Prevention of Perinatal Group B Streptococcal Disease (GBS) with Prophylactic Antibiotics (Jan 2013)

Access the full Cochrane Review abstract here.

LMs and CNMs in WA can access the full text Review through Heal-WA.

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

Hi-lights from the 2010 Revised CDC Guidelines on the Prevention of Perinatal GBS Disease

SOGC Clinical Guidelines (2004) - PDF

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

"Immediate or early cord clamping vs delayed clamping." by DJ Hutchon. in the Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2012 Nov;32(8):724-9. doi: 10.3109/01443615.2012.721030. Full Text Article available online and through Heal-WA.

"Rethinking placental transfusion and cord clamping issues." by Mercer JS, & Erickson-Owens DA. in The Journal of Perinatal and Neonatal Nursing. 2012 Jul-Sep;26(3):202-17; quiz 218-9. Article available to LMs and CNMs through Heal-WA.

The Royal College of Midwives (RCM) in the UK is set to issue advice that midwives should wait before cutting the umbilical cord. Read More.

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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