23 - Midwifery in Texas: Neonatal Outcomes and Trends at the Population Level

Poster Number: 23
Publication Number: 23.338

Erica Ding, Baylor College of Medicine, Houston, TX, United States; Charleta Guillory, Baylor College of Medicine, Houston, TX, United States; Caraciolo J. Fernandes, Baylor College of Medicine, Houston, TX, United States; Carla Ortique, Baylor College of Medicine, houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Amaryllis Fernandes, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Medical education has increasingly taught about the roles of other healthcare workers in recognition of the importance of understanding other disciplines that provide care to patients or cover gaps in healthcare providence. Midwives is one such group that provides obstetric and gynecological care as well as the care of newborns, though it is a group that physicians often know little about. Understanding midwives is further complicated by different midwifery regulations amongst states, which affect the data available on midwives’ practices.

Objective: We sought to better understand midwives in Texas, who they serve, and the outcomes of birth they attended.

Design/Methods: In Texas, there are two broad groups of midwives, Certified Nurse Midwives (CNMs) and Licensed Midwives (LMs). With aggregate data obtained from the Texas Department of State Health Services (DSHS) from 2015 to 2019, we quantified and trended how many births each of these two groups of midwives attended across Texas and Texas Public Health Regions (PHRs), which ethnic groups most utilized their services, and perinatal outcomes of newborns they delivered, namely prevalence of neonatal intensive care unit (NICU) admissions and ranges of reported 5-minute Apgar scores.

Results: We found that while the proportion of births attended by CNMs had remained steady at approximately 3% of all total births, births attended by LMs increased from 1% to almost 2% between 2018 and 2019 especially in PHR 5 (covering Harris County) and 8 (covering Victoria County). PHR 10, covering West Texas, saw the highest prevalence of births attended by LMs. Consistently, Non-Hispanic Whites utilized both types of midwives more than other ethnic groups do. Prevalence of neonatal intensive care unit (NICU) admission for newborns delivered by both types of midwives are lower than the states’ average, though between 2018 and 2019, births attended by LMs that required NICU admission more than doubled from 1.7% to 3.5%. Overall, both types of midwives reported reassuring 5-minute Apgar scores that range from 8 to 10 for births they attended.Conclusion(s): Our study is the first of its kind to examine perinatal data amongst births attended by Texas midwives, and demonstrated overall good outcomes for births attended by midwives. With almost 5% of the state’s total births delivered by midwives, we believe that education about our midwife colleagues and understanding midwifery practices is informative to any Texas pediatrician. We hope that this study will prompt further and more in-depth research into Texas midwives and the roles they play in our community.
Erica Ding CVCV from Erica Ding.pdf