With power outages and last-chance summer vacations, it feels a bit like life has slowed down in anticipation of the busyness that comes with fall. But while conference calls and meetings are a little sparser, the medical literature seems to be serving up a larger than average helping of important evidence and commentary. Maybe your Labor Day Weekend reading list has lighter fare, but here’s what we’re reading…
On the heels of a joint statement released last April from ACOG and ACNM, the two organizations (representing ob-gyns and nurse-midwives, respectively), have announced the winning papers among 60 submitted on the Issue of the Year, “Successful Models of Collaborative Practice in Maternity Care.” The articles appear in the current issue of Obstetrics and Gynecology and will be in a forthcoming issue of The Journal of Midwifery and Women’s Health.
- Obstetrician and Nurse-Midwife Collaboration: Successful Public Health and Private Practice Partnership by Shaw-Battista and colleagues at Sutter Davis Hospital provides results from a quality assessment study showing few differences in the outcomes or process of care between first-time mothers receiving care in a collaborative private practice setting and those receiving care in a midwife-led federally qualified health center. These data suggest that low-tech, high-touch collaborative care may have a role in reducing disparities.
- A Northwest Collaborative Practice Model by Darlington and colleagues describes the innovative care delivery model at Group Health in Washington where all providers have a well defined independent scope of practice and are salaried, and thus are not rewarded financially for performing more procedures. The latter “removes an economic incentive for intervention and enables us instead to focus on medical necessity, patients’ desires, medical evidence and safety concerns. The lack of financial incentive (and therefore competition) aids the smooth transfer of care between practice groups.” (p. 675)
- Great Minds Don’t Think Alike: Collaborative Maternity Care at San Francisco General Hospital by Hutchison and colleagues describes how collaboration can go beyond delivering maternity care to organizing, improving, and evaluating care processes. The article addresses how obstetricians and midwives have worked together to implement the CenteringPregnancy model of group prenatal care, earn designation as a Baby Friendly Hospital, and develop evidence-based hospital policies and safety checklists.
- Making it Work by DeJoy and colleagues describes collaborative practice at Baystate Medical Center, a large academic center serving a diverse population where the midwifery role extends to providing care in a correctional facility, covering the obstetric triage unit, and educating medical students and obstetric residents.
- Contemporary Labor Patterns: The Impact of Maternal Body Mass Index provides data from the multi-center Consortium on Safe Labor and concludes that labor care should be altered to accommodate slower progress in women with high BMI.
- Impact of Multiple Cesarean Deliveries on Maternal Morbidity: A Systematic Review includes data on over 2 million births from 21 studies and reports that rates of hysterectomy, blood transfusions, adhesions, and surgical injury all increased with increasing number of cesarean deliveries. Rates of placenta previa, placenta accreta, and the two in combination were especially elevated in women with 3 or more cesareans.
- How to Develop an Effective Obstetric Checklist reviews existing obstetric safety checklists, summarizes the impact of checklists on safety and liability, and proposes standards for developing checklists for obstetric practice.