Journal of midwifery & women's health最新文献

As we welcome 2025 and begin celebrating 70 years of the American College of Nurse-Midwives (ACNM) and the Journal of Midwifery & Women's Health (JMWH), a recent World Health Organization (WHO) report¹ should be in the hands of every practicing midwife. In the United States in particular, this position paper can help promote midwifery care models at the federal, state, local, and health system practice levels. WHO recommends a transition to midwifery care models worldwide, linked to a strategy of primary health care as part of attaining universal health coverage.

WHO urges moving from fragmented and risk-focused care approaches to midwifery models of care so that women and newborns receive “equitable, person-centred, respectful, integrated and high-quality care, provided and coordinated by midwives working within collaborative interdisciplinary teams”^1(p8) prior to pregnancy through the postpartum period. The report notes that while the terms women and mothers are used, the recommendations are inclusive of all individuals identifying as women and all persons who give birth. Although improvements have been made in maternal and neonatal outcomes globally, many challenges remain. Improvements are needed in both access to health care and the provision of high-quality care. In addition, inappropriate use of medical interventions is highlighted as a barrier to improving perinatal outcomes.

Midwifery models of care are defined as those consistent with midwifery philosophy and where the care is provided by autonomous midwives who are educated, licensed, and regulated. Midwives provide high-quality care that is person-centered, based on a relationship between the midwife and the woman, promotes physiologic processes, with interventions used only when needed. Care is coordinated within resourced and functional health systems where interprofessional teams function with respect and trust. These care models are modifiable to be used in all care settings and related contexts.¹

Principles of midwifery models of care include (1) access to equitable and human rights–based care for all women and newborns, (2) person-centered and respectful care in a partnership between women and midwives, (3) high-quality care consistent with midwifery philosophy, (4) care provided by autonomous, educated, regulated midwives throughout health systems, and (5) midwives are integrated into interprofessional care teams.¹ By using models incorporating these principles, WHO believes a transition to midwifery models can save lives, improve women's and newborns' health outcomes, improve satisfaction with care, reduce health inequities, promote women's rights, and maximize the use of health care resources.¹

In making the case for midwifery care models, the WHO report synthesizes recent research and other repo

Las parteras en los Estados Unidos (EE. UU.) proporcionan servicios de atención médica a individuos en todas las etapas de la vida. Colaboran con sus pacientes/clientes en la toma de decisiones importantes sobre su salud. Trabajan en conjunto con otros miembros del equipo de atención médica cuando es necesario. También pueden ser proveedoras de atención primaria.

Es importante aclarar que el término “partera” en Latinoamérica no corresponde a la profesión de partería que se practica en EE. UU. El tipo de educación, el proceso de acreditación para ejercer esta profesión, la percepción cultural, el respaldo legal, y la relación con otros profesionales de la salud y con los centros de salud que tienen las parteras en EE.UU son diferentes que en muchas otras partes del mundo. Las parteras en EE. UU. tienen un alcance profesional que es parecido al de los gineco-obstetras, aunque con diferencias importantes.

Las enfermeras parteras certificadas (CNM, por sus siglas en inglés) y parteras certificadas (CM, por sus siglas en inglés) se han educado en programas acreditados y han aprobado un examen de certificación nacional. Deben tener una licencia para practicar en el estado donde trabajan. Tanto las CNM como las CM atienden a sus pacientes en todos los tipos de centros de salud, incluyendo los hospitales, los centros de maternidad, clínicas o consultorios, y también en el hogar. Proporcionan atención general durante el embarazo (seguimiento prenatal) y durante el parto, atención de salud reproductiva y también cuidado primario. Pueden recetar la mayoría de los medicamentos. Tanto las CNM como las CM pueden cuidar a los recién nacidos durante los primeros 30 días de vida.

Las parteras certificadas profesionales (CPM, por sus siglas en inglés) pueden haber tenido capacitación como aprendices o pueden haberse graduado de un programa de educación acreditado. Han tomado un examen de certificación nacional diferente al que toman las CNM o las CM. Las CPM proveen cuidado durante el embarazo, el nacimiento y después del parto en entornos comunitarios, usualmente en centros de maternidad o en los hogares. También proveen cuidado de los recién nacidos. No pueden recetar la mayoría de los medicamentos. Tampoco trabajan en hospitales.

La mayoría de las parteras en EE. UU. son CNM y tienen licencia en los 50 estados. No todos los estados conceden licencia a las CM ó a las CPM.

Las parteras proveen atención durante el embarazo, el trabajo de parto, el nacimiento y el posparto. También atienden a bebés recién nacidos. Las CNM y las CM cuidan a aproximadamente 1 de cada 10 mujeres que dan a luz cada año en EE. UU. Además de ser expertas en salud reproductiva, las CNM y las CM proveen atención primaria de salud. Los cuidados que brindan incluyen exámenes físicos anuales, planificación familiar, cuidado durante la menopausia, detección y tratamiento de infecciones de transmisión sexual y otros problemas de salud. Las

Individuals who are at risk of not achieving a full milk supply are often overlooked in scientific literature. There is available guidance to help establish an adequate milk supply for healthy individuals experiencing a physiologic labor and birth, and there are robust recommendations for the lactating parents of small, sick, and preterm newborns to ensure that these newborns can receive human milk. Missing from the literature are clinical practice guidelines that address the preexisting health, pregnancy, birth, or newborn-related risk factors for suboptimal lactation. This can include risk factors that impact secretory activation or newborns who may not attach and suckle effectively to provide the stimulation and removal necessary to reach full milk volume. Secretory activation can only occur after the birth of the newborn and the placenta, with milk volume being established during the first weeks of breastfeeding. Recognizing this gap, over the past 2 years, an international group of midwives led by a doctoral nurse scientist in lactation conducted an extensive literature review to identify the most significant risk factors that can disrupt normal physiologic lactation. Our group sought to establish proactive lactation management strategies to ensure long-term milk production. We developed an evidence-based perinatal operational breastfeeding plan alongside clinical pathways to guide health care professionals in assessment, care, and necessary education for families who present with risk. Our goal is for midwives and other health care professionals to integrate the perinatal operational breastfeeding plan into practice and use these pathways to ensure (1) timely and effective secretory activation, (2) building a milk supply as robust as feasible for personal situations and conditions, (3) more newborns receiving more human milk and (4) more families achieving their personal breastfeeding goals.

National health policy initiatives recommend increased integration of midwifery care in the United States to improve care quality and reduce maternal health disparities. However, the service models through which midwives provide midwifery care and produce quality outcomes are poorly understood. Midwifery-led care is a service model frequently associated with improved outcomes compared with other models. The service model has been infrequently or inconsistently studied in the Unites States and has been narrowly defined and applied to perinatal care. The purpose of this concept analysis was to evaluate the concept of midwifery-led care and expand the definition to guide midwifery practice, research, and health policy. The analysis followed Walker and Avant's methodology. Three attributes of midwifery-led care were identified: (1) midwife as the lead clinician; (2) person-midwife partnership; and (3) care embodies midwifery philosophy. Antecedents were (1) license to practice as a midwife; (2) a person needing or desiring sexual, reproductive, perinatal, or newborn care; (3) a person with low- or moderate-risk health status; (4) regulations and guidelines that support provision of midwifery care; and (5) reimbursement for services. Consequences of midwifery-led care included (1) improved maternal and neonatal outcomes, (2) patient satisfaction, and (3) reduced health care costs. The presented expanded definition of midwifery-led care is the first to use a systems level approach and explicitly center the person receiving care and the philosophical approach of midwifery care. Application of this definition is needed in theoretical and pragmatic research to classify midwifery-led care and other service models and compare patient- and organization-level outcomes.