Journal of midwifery & women's health最新文献

The authors thank Ms. DeLuca for engaging with our recent article and emphasizing the role of interprofessional collaborations and training to improve rural midwifery care access.¹ We agree and see this as both a policy and research issue. The questions raised are timely, as recent research has shown continued labor and delivery unit closures disproportionately impacting rural US hospitals,² further limiting rural residents’ access to local perinatal care.

The letter's author highlights numerous factors that may inhibit the growth of rural midwifery, including workforce shortages of other types of perinatal care clinicians, geographic barriers to care, and a lack of infrastructure to incorporate the midwifery model in established practices. Underpinning each of these barriers is the impact that state-level midwifery practice legislation has on the growth of the midwifery care workforce.

The American College of Nurse-Midwives has identified numerous state policies governing certified nurse-midwife and certified midwife (CNM/CM) practice that can expand the midwifery workforce. These include licensure policies for different types of midwives, Medicaid reimbursement parity between midwives and physicians, and whether midwives have the authority to prescribe medications and admit patients to hospitals without physician oversight.³ Researchers have demonstrated such policies’ potential impacts. States with independent practice legislation for CNMs have more practicing midwives per 1,000 births and fewer counties without midwives compared to those that require CNMs to hold practice agreements with supervising physicians.⁴

Enabling CNMs/CMs to practice independently may have particularly salient effects on the perinatal care workforce in rural areas. Though CNMs/CMs can provide safe, high-quality care within their scopes of practice without physician oversight,⁵ requiring physician supervision may restrict midwives’ ability to provide care in rural areas,^{3, 4} even if they desire a rural practice, because clinicians like obstetrician-gynecologists are more concentrated in urban areas.⁵ In contrast, independent practice legislation may enable CNMs/CMs to practice in communities that otherwise have shortages of perinatal care providers or are longer distances from high-volume or higher acuity clinical settings.

Similar policies that reduce restrictions for certain types of midwives, such as certified professional midwives (CPMs), may be particularly resonant in rural areas. CNMs/CMs are more likely to be concentrated in urban areas,^{3, 5} while a greater proportion of rural births are attended by CPMs and other types of midwives compared to CNMs/CMs.⁶ Further, as CPMs and other types of midwives are more likely than CNM

Biodynamic interventions are targeted suggestions for postural changes thought to quicken the progress or ease the discomfort of labor and birth, especially when fetuses are not in the optimal position. Although biodynamic interventions carry almost no risks and come from a rich anecdotal body of evidence, they have generally not been subject to rigorous evaluation. Current clinical practice guidelines support the use of intravenous oxytocin and manual or instrumental rotation for delayed labor progress and fetal malposition; however, these interventions are associated with increased risks of maternal and neonatal morbidities. The use of biodynamic interventions may be an effective alternative to optimizing fetal position and labor progress, with fewer associated risks. This state of the science review examines research describing the efficacy of various biodynamic interventions on labor progress, fetal malposition, and mode of birth within specific clinical contexts. The review also seeks to draw out key findings for clinical practice and identify gaps in the literature for future research.

Artificial Intelligence (AI) is all around us. An email titled Meet Gemini, your new AI assistant appeared in my email inbox recently. I was curious about what might be available to help me to become more efficient. I was also a little skeptical and even more cautious. Might this new assistant suggest something inappropriate, irrelevant, or even false?

Questioning the use of AI technologies is particularly relevant in scholarly publishing for authors, editors, peer reviewers, and even everyday readers. We typically ask: were the research methods sound, was the analysis done correctly, are the conclusions appropriate? What is most important to consider related to AI when interacting with the Journal of Midwifery & Women's Health (JMWH) and other scholarly journals?

First, some definitions of AI may be helpful. One expert defined AI as “algorithmic-based technologies that solve complex tasks which previously required human thinking.” Another simply referred to AI as “whatever hasn't been done yet.” In addition, the expert clarified that the intelligence part of AI includes both learning and thinking. A third expert explained AI technologies as requiring higher-level knowledge to do their work.¹

New tools referred to as generative AI or GenAI have become available in the last several years. This large language model technology refers to tools that learn from large amounts of publicly available information, including the possibility of copyrighted material, and can generate content such as human-sounding text, images, audio, and video. Numerous ethical concerns have been raised related to their use in scholarly publishing.² These are important questions to ask and answer, including topics such as intellectual property, other rights to material, privacy, and confidentiality.³ Questions are also being raised about known biases in GenAI based on the material used to train programs and the possibility of amplifying existing biases that may worsen health disparities rather than helping to make improvements. Expert humans guiding the tool development and training will be essential to prevent harm from poorly developed tools.⁴

The JMWH Editors and Associate Editors approved a new editorial policy related to AI use in 2024.⁵ The policy interprets guidance provided by thought leaders in scholarly publishing such as the World Association of Medical Editors⁶ and the JAMA Network, publisher of the AMA Style Guide, adopted by JMWH.⁷ Authors remain ultimately responsible for all information in their published work, including proper citing of sources, lack of plagiarism, and any material derived from AI tools. Any use of such tools must be acknowledged, including which tool(s) were used and how they were used. In addition, GenAI