Midwife Connection

by Cassie Moore, ACNM writer and editor

In honor of Prematurity Awareness Month, ACNM and Barbara Hughes, CNM, are gearing up for a free resource-packed CE webinar “Real-Life Strategies for Preterm Labor and Birth” on Tuesday, November 15 at 6:00PM and again at 8:00PM EST. Using real-life patient scenarios that you deal with every day, Hughes will share information about a new March of Dimes risk assessment toolkit, when and how to use the fetal fibronectin test, current recommendations for antenatal steroids, and new data about delayed cord clamping for preterm infants. We recently caught up with Hughes to get the scoop on the upcoming webinar.

Midwife Connection: Why should midwives participate in this webinar?
Barbara Hughes: We have a prematurity crisis in America and it’s important for midwives to be well-equipped with knowledge about patient counseling, risk assessment, screening, and treatment of preterm labor.

MC: Can you give an example of the real-life scenarios you’re going to discuss in the webinar?
BH: In 50 percent of preterm deliveries, women don’t have any risk factors at all and still end up delivering a preterm infant. So we want to talk about women without risk factors. We’ll also talk about women who have had a history of preterm birth, and we’ll talk about management of patients in a variety of midwifery practice models.

MC: The March of Dimes’ Web site notes that premature birth has increased by 36 percent since the early 1980s—why do you think this is?
BH: There are a lot of theories. One of the reasons may be the increase in multiples—twins, triplets—and that’s related to artificial reproductive technology. But because we don’t know the reason, or there are no risk factors for 50 percent [of preterm births], there’s a little bit of a mystery there. Some people think it has to do with infections that might not necessarily be detected during pregnancy, some people think it has to do with stress, because women in today’s society are definitely experiencing more stress. We also see a disproportion of preterm births in African American women that is alarming.

MC: What new data regarding delayed cord clamping do you plan to discuss?
BH: Traditionally, when the baby is born, the clinician immediately clamps and cuts the cord and the baby is placed on the mom’s abdomen for skin-to-skin contact or the baby is handed off to a pediatric provider. There is a good body of data that supports leaving the cord intact for a healthy term infant, and let the baby go right to mom’s tummy, and let the cord continue pulsing for two minutes or until it stops on its own—research has looked at different time frames. The theory behind that is that it gives the baby an extra boost of blood. For preterm infants, [clinicians are] so concerned about resuscitation of the baby, typically they quickly cut the cord and hand the baby off to a pediatric provider. We saw a new article come out a few months ago* that actually recommended milking the cord or delaying cord clamping for a minute or two if the preterm infant is stable, and it really gives the baby a significant advantage in the days and, they think, even months after birth.

MC: What else do you plan to talk about?
BH: I want to make sure that people have information they can put into application regardless of setting. For example, if a midwife is practicing in an out-of-hospital setting, she may have a reason to refer a woman to a hospital setting for comprehensive evaluation. I’m also going to talk about the fetal fibronectin test and assessing for ruptured membranes.

MC: Let’s talk about the fetal fibronectin test: Is this test routinely done, or only done if the client presents risk factors?
BH: Women who have risk factors may be screened, or for women who present with signs and symptoms of preterm labor, the fetal fibronectin test can help direct the management. If you have a positive fibronectin test, it doesn’t tell you that the woman will have a preterm baby, but that she’s at a greater risk. So let’s say in Colorado, she lives in the mountains two hours away from a hospital that has a NICU. I’m going to recommend that she finds a place to stay close by, and really carefully listens to her body and call if she has any signs or symptoms. If she has a negative fetal fibronectin test, I’m going to be a little bit more comfortable about sending her home.

Real-Life Strategies for Preterm Labor and Birth is supported by an unrestricted educational grant from Hologic, Inc. Space is limited, so register for the webinar today! Click here for more information and to register.

*Rabe et al; Milking Compared with Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: Obstetrics & Gynecology; VOL. 117, NO. 2, PART 1, FEBRUARY 2011