Perinatal substance use disorders (PSUDs) are a leading cause of maternal mortality and morbidity during the pregnancy and postpartum periods. This study aims to assess the incorporation of PSUD training in midwifery education programs and provide actionable recommendations for enhancing midwifery training.
A cross-sectional survey was administered to US certified nurse-midwifery and certified midwifery education program directors regarding the didactic and clinical education their students received.
There were 35 of 39 programs that responded to the survey. Findings indicate that most midwifery programs provide didactic content, but less than half of midwifery programs provide clinical experiences for their students. Most programs provide didactic content covering nicotine and tobacco cessation, perinatal alcohol use, epidemiology of substance use disorders, and screening for substance use disorders.
Program directors identified several barriers to enhanced PSUD education and clinical experience for their students, including lack of dedicated perinatal addiction clinicians, lack of faculty expertise, lack of time in the curriculum, and lack of time by faculty, among others.
Cytomegalovirus (CMV) infection immediately before or during pregnancy can infect a fetus transplacentally, causing congenital CMV (cCMV). cCMV can cause miscarriage, stillbirth, growth restriction, neurodevelopmental delay, hearing, and vision impairment. This integrative review examined original research to better inform health care providers on methods for reducing cCMV infections.
Database searching to identify original research pertaining to cCMV prevention in CINAHL, PubMed, and Nursing and Allied Health in January 2024 produced an initial 417 initial studies. Final extraction included 34 studies that met inclusion criteria for analysis.
Three relevant themes emerged: education, screening, and treatment. Messaging and education focused on risk reduction as most effective for behavioral changes. Maternal screening did not predict cCMV in low-risk women; however, it did diagnose early-stage maternal infections. Initiation of treatment closer to infection diagnosis demonstrated better outcomes. The 2 main treatment options for maternal infection were valacyclovir 8 g daily orally and CMV-hyperimmunoglobulin (HIG) 100 or 200 units per kilogram via intravenous (IV) infusion at varying frequency. Research on the efficacy of valacyclovir showed reductions in the incidence of cCMV without adverse maternal effects. Reduction in neonatal transmission and adverse sequelae were more likely with the 200 units per kilogram dosing of IV administration of HIG-CMV compared with the lower dose of 100 units per kilogram.
cCMV is often overlooked and untreated. Education in a variety of formats is effective at increasing provider knowledge and reducing infection rates by influencing maternal behavior. Screening recommendations are inconsistent but can be used as a tool to identify those pregnant individuals at highest risk, which could facilitate early diagnosis and prompt treatment. Maternal administration of medications such as valacyclovir and HIG-CMV have been shown to reduce the incidence of cCMV. Treatment options for CMV infection in pregnancy and resources for patient education are available and can reduce transmission to the neonate.
Everyone has the right to give birth in a safe place where they feel comfortable. You can choose to give birth at home, in a birth center, or in a hospital. The decision is an important one based on your health and preferences. Talk to your provider about benefits and risks to you and your baby based on your chosen birth setting.
If you choose a home birth, you will have regular visits with a midwife during your pregnancy. Sometimes they will come to your home for the visits. Sometimes you may go to an office or clinic. When your labor begins, the midwife will come to your home. You will need to prepare your home for the birth. This includes getting some supplies. The midwife will bring the needed birthing equipment and a few medications to care for you and your baby. The midwife and another person trained in newborn care will be present when you give birth. The midwife will usually stay for several hours after your baby is born to make sure you are both doing well.
A birth center is a home-like space set up for labor and birth. Birth centers may be freestanding (in a building or house located away from a hospital) or attached to a hospital. Your prenatal visits and birth will occur with a midwife at the birth center. They will provide the supplies, equipment, and medications you might need. You usually stay in the birth center for several hours after you give birth.
Most people in the United States give birth in a hospital even if they are healthy. Hospitals offer different types of care during pregnancy. Some hospitals have separate areas for labor and postpartum care. Others have special rooms where a person can labor, give birth, and then stay until they go home. A tour of the hospital's labor and delivery area and discussion with the staff will help you find out what services your hospital offers.
You may want to consider costs of each setting and what services your insurance will cover. The following lists can help you choose the birth setting that is best for you.
Key Differences in the 3 Birth Settings
Flesch-Kincaid Reading level 7.2
Approved February 2025. Replaces “Choosing Where to Give Birth” published in Volume 61, Issue 2, March/April 2016
This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.
A rapidly growing rural community of Old Order Mennonites in upstate New York abruptly lost midwifery services in 2018, causing a crisis in perinatal care access. A mixed-methods study was undertaken to explore health status, perinatal needs, and preferences in this culturally homogenous group.
An anonymous survey mailed to 650 Mennonite families assessed demographic characteristics, general health, perinatal optimality, perinatal care characteristics, stress and anxiety related to rural childbearing, and preferences for a perinatal health care system. Voluntary follow-up telephone interviews explored recent perinatal experiences and desires for future care.
Surveys were returned by 218 Mennonite women, a 33.5% response rate. Home birth was preferred by 94.6% of participants. The mean (SD) Perinatal Background Index score was 86.7% (11.7), indicating a high level of optimality. Elevated levels of stress and anxiety, as measured by the Rural Pregnancy Experience Scale, were reported by 12 participants (6.6%). Qualitative descriptive analysis of 21 interviews revealed a strong desire to preserve home birth, receive care that was respectful of Mennonite cultural norms, and maintain a personal choice of birth attendants.
According to participants, an ideal perinatal care system would ensure locally available, skilled midwives willing to maintain the community's traditional childbearing practices. Despite rural remoteness, distance from inpatient perinatal services was not associated with increased stress and anxiety. Access to care could be improved by state-level initiatives to expand the licensure of midwives and to remove barriers to birth center development.
Oral health, the health of your teeth and gums, is important before, during, and after pregnancy. Normal changes that occur during pregnancy can affect the teeth and gums. These include hormone changes, nausea and vomiting, and changes in your diet and lifestyle.
During pregnancy, the placenta releases the hormones progesterone and estrogen. The increases in these hormones can cause changes in your mouth. This can lead to swelling or bleeding of the gums, loosening of the teeth, and increases in saliva. Progesterone and estrogen increase the risk of infection, cavities, and damage to the structures that support the teeth. Changes to the immune system during pregnancy increase the chance of infections that can affect the health of teeth and gums. Most issues can be prevented if you take good care of your mouth and will go away after the birth of the baby. However, if you have severe problems with your mouth before pregnancy, they may get worse and need more treatment.
Dental care during pregnancy is safe and recommended to improve oral and general health. Most people don't get the treatment they need. It is also important for your baby's health. Teeth cleaning, dental x-rays, and most dental treatments can be safely done when you are pregnant. Make sure your dentist knows that you are pregnant. If medications for infection or pain are needed, your dentist can prescribe safe choices for you and your baby. Tell your dentist or health care provider about any changes in your mouth, teeth, or gums you have noticed since you became pregnant. Your dentist will determine if x-rays are needed. Your belly should be covered with a lead apron during x-rays to protect you and your baby.
Flesch-Kincaid Grade Level: 6.6
Approved February 2025. This handout replaces “Dental Care in Pregnancy” published in Volume 59, Number 1, January/February 2014 and “Oral Health: Keeping Your Mouth Clean and Healthy” published in Volume 56, Number 2, March/April 2011.
This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.
Gestational diabetes (GDM) affects 1 in 6 pregnancies worldwide1 and around a third of those diagnosed with GDM will develop Type 2 diabetes mellitus (T2DM) within 15 years.2 Follow-up care for people with GDM therefore offers an opportunity to detect blood glucose abnormalities early and reduce the risk of T2DM complications.2 Recommendations for postpartum GDM care focus on glucose testing and health education for lifestyle changes.3 Guidelines recommend that people with GDM should undergo glucose testing with an oral glucose tolerance test or with hemoglobin A1c (HbA1c) at 6 to 12 weeks postpartum to exclude T2DM. HbA1c or fasting glucose testing at regular 1 to 3 year intervals is advised to identify progression to T2DM.3 People diagnosed with GDM should be offered lifestyle advice on weight control, diet, and exercise, which may be delivered via structured education programs.3
Although guidelines emphasize the importance of providing follow-up care to people with prior GDM,3 this care is often lacking. A recent editorial in The Lancet highlights the slow progress made in implementing GDM follow-up care, despite its potential to improve long-term cardiometabolic health.4 Uptake of glucose screening is poor globally, with only a third of people with prior GDM receiving regular screening as recommended.5 Barriers to screening include a lack of clear guidance about T2DM risk, competing responsibilities such as work or childcare, and poor continuity between pregnancy and primary care services.6 Behavioral interventions for T2DM prevention have also had mixed success.7 Only 2 of 13 controlled trials regarding lifestyle interventions for people with prior GDM showed significant reduction in T2DM, and there is evidence of publication bias.8 All this suggests that postpartum glucose screening and education interventions have not had the desired effect.
Public health interventions are complex, involving multiple stakeholders and unpredictable outcomes. One way to understand and improve these interventions is by using theory: frameworks of ideas or concepts to explain how something works or why something happens. Theoretical frameworks can help policymakers and health care professionals understand the behavior of key stakeholders, identify appropriate strategies for change, and predict possible outcomes. By incorporating social, psychological, and behavioral factors, theory provides useful insight when developing new interventions or assessing why existing ones have not been successful. However, interventions for T2DM prevention in people with GDM often lack theoretical grounding, and few studies specify a theoretical framework for their interventi
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