Study: Risk Stratification at Term Reduces Adverse Outcomes
A new population-based cohort study demonstrates that stratifying maternal risk at term and planning births accordingly can reduce adverse perinatal outcomes. The research, published by the American Journal of Obstetrics and Gynecology, provides probabilities of adverse outcomes for each gestational week, broken down by risk category. Video insights accompanying the study emphasize using this evidence to optimize the timing of births.
- The study analyzed over 1.1 million singleton births at or beyond 37 weeks in Queensland, Australia, between 2000 and 2021, categorizing pregnancies into low, intermediate, and high-risk groups. For high-risk women, planned birth between 38 and 39 weeks was associated with the lowest odds of adverse outcomes compared to waiting for spontaneous labor. - This evidence-based approach to risk stratification aligns with the core of midwifery practice, which integrates research with clinical expertise and patient preferences. However, the American College of Nurse-Midwives (ACNM) currently discourages labor induction without a clear medical indication, emphasizing shared decision-making between the provider and patient. - Implementing such risk-based care models is critical in Virginia, where approximately 36% of counties are classified as "maternity care deserts" with little to no access to obstetric providers, including certified nurse-midwives. - The nurse-midwife profession is projected to grow by 35% between 2024 and 2034, a rate much faster than the average for all occupations, which could help address significant workforce shortages. In Virginia, recent legislation aims to tackle these shortages by expanding the roles of certified nurse-midwives. - As of July 1, 2025, House Bill 1904 will allow certified nurse-midwives to provide nursery care in hospitals when a pediatrician is unavailable, a move aimed at keeping rural labor and delivery units open. - The Virginia affiliate of the ACNM also celebrated the passage of House Bill 1923, signed into law in May 2025, which mandates insurance reimbursement parity for all licensed midwives, ensuring they are paid at the same rate as their certified nurse-midwife counterparts for the same services. - Emerging digital health platforms and AI-powered models are being developed to help clinicians implement this type of risk stratification by collecting patient data, predicting risks of adverse outcomes, and guiding clinical decisions for personalized prenatal care.
