Passive Descent, Prolonged Pushing, and the Power of Midwifery Data

Passive Descent, Prolonged Pushing, and the Power of Midwifery Data

Every midwife knows the tension. How long is too long in second stage, and what does the evidence actually say about letting someone labor down? In this episode of Speaking of Midwives, our host Dr. Melissa Avery sits down with Dr. Elise Erickson, midwife, PhD, and associate professor at the University of Arizona, to discuss her research published in the Journal of Midwifery & Women's Health examining the role of passive descent and epidural analgesia in outcomes associated with prolonged pushing among nulliparous midwifery patients. Drawing from a prospectively collected dataset of nearly 1,500 births across a midwifery practice in the Pacific Northwest, Dr. Erickson unpacks what the data reveals about prolonged pushing, cesarean risk, obstetric anal sphincter injury, and the nuanced, and often underdocumented time between full dilation and active pushing. Elise issues a compelling call to action for midwives everywhere who are benchmarking their outcomes: your data matters, and the profession needs it. This is exactly the kind of midwifery-led, practice-informed research that is building the evidence base one dataset at a time.Article: Erickson EN, Hersh SR, Wharton MR, Bovbjerg ML, Tilden EL. The Role of Passive Descent and Epidural Analgesia in Outcomes Associated With Prolonged Pushing Among Nulliparous Individuals in Midwifery Care. J Midwifery Womens Health. 2024; 69(4): 499-513. https://doi.org/10.1111/jmwh.13624Citations for two other articles Elise mentions in this episode:Cahill AG, Srinivas SK, Tita ATN, et al. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial. JAMA. 2018;320(14):1444–1454. Doi:10.1001/jama.2018.13986Montfort E, Nallet C, Cot S ...Active second-stage duration under 15 minutes in spontaneous vaginal deliveries with delayed pushingAmerican Journal of Obstetrics & Gynecology, 2025; 234, 1470-1477Dr. Erickson's Links:website is www.mumhlab.com Instagram at @mumhlab

Drivers and Barriers to Precepting Midwifery Students

In this episode of Speaking of Midwives, host Melissa Avery, PhD CNM sits down with Dr. Julie Blumenfeld, Associate Professor and Midwifery Program Director at Rutgers University, to tackle one of the most critical challenges facing the profession today: the clinical preceptor shortage. Despite the growing demand for midwifery care in the United States, securing clinical sites remains a complex hurdle for students and program directors alike. Dr. Blumenfeld shares insights from her recent study, "Identifying Drivers and Barriers to Precepting Midwifery Students," using a socio-ecological lens to understand why midwives say "yes" (or "no") to teaching the next generation. The "Time vs. Teaching" Tug-of-War: How to balance high-volume patient panels with the responsibility of clinical instruction without burnout. The Support System: Why institutional backing and workload reduction are essential to making precepting sustainable, rather than a "series of personal favors." Recharge and Renewal: How seasoned midwives find renewed energy and stay current with their skills through the infectious enthusiasm of students. Policy and Funding: The urgent need for federal support—including the Midwives for MOMS Act—to modernize clinical education and provide parity with medical residency funding. Equity in Education: A look into the SIMPL study and the importance of addressing the unique barriers faced by sexual and gender minority students. Precepting isn't just an "extra" task; it is a core professional competency and the heartbeat of the midwifery pipeline. Whether you are an early-career midwife or a veteran practitioner, discover how you can advocate for teaching rights in your contracts and help ensure the profession continues to thrive. Credentials: Julie Blumenfeld, DNP, CNM, FACNM, FAAN Blumenfeld J, Alspaugh A, Wright L, Lindberg L. Identifying Drivers and Barriers to Precepting Midwifery Students: “A Little Part of Me Lives on in Each Student Midwife”. J Midwifery Womens Health. 2024;69(5):727-734. https://doi.org/10.1111/jmwh.13654 [https://doi.org/10.1111/jmwh.13654] Resources: * The New Jersey Midwifery Education Project: Access the Preceptor Learning Platform [https://rutgers.edu/] for asynchronous CEs and clinical teaching strategies. * Midwives for MOMS Act: Learn more about pending federal legislation to support midwifery workforce development. Connect with Us: If you enjoyed this episode, please subscribe and leave a review. Your support helps us bring midwifery-led research to the forefront of maternal health.

Labor Induction Outcomes in Hospital-Based Midwife-Led Care

Since the landmark ARRIVE trial reshaped labor induction practices across the country, midwives have been asking, what do these findings actually mean in the hands of midwifery-led care? In this episode of Speaking of Midwives, host Melissa Avery sits down with Dr. Denise Smith, midwife, researcher, and assistant professor at the University of Colorado, to discuss her recently published study in the Journal of Midwifery & Women's Health examining outcomes for labor induction compared with expectant management across four diverse midwifery practice groups serving more than 7,000 births.Dr. Smith and her team at the Midwifery Reach research lab set out to answer what clinicians were already asking in practice, does induction of labor increase cesarean birth rates in midwifery-managed settings? The findings are both reassuring and revealing, with important implications for how midwives counsel patients, manage labor, and advocate for resource equity.This is midwife-led research, answering questions that matter most to midwifery practice. These conversations are exactly what Speaking of Midwives is here for.Smith DC, Gemkow JW, Shiferaw BA, Anderson J, Bulinski D, Brody MG, Carrington S, Cherry C, Pirrie SM, Williams A, Smyth HL, Kissler KJ. (2026), Outcomes for labor induction compared with expectant management among women receiving hospital-based, midwifery-led care. J Midwifery Womens Health. Published in EarlyView April 2026.

Communication Between Pregnant People of Color and Care Providers

What does the research tell us about how pregnant people of color experience communication with their care providers? What can midwives do about it right now? In this episode, we sit down with Amy Goh, CNM, PhD, whose integrative review published in the Journal of Midwifery & Women's Health examined communication dynamics between pregnant people of color and their prenatal care providers across the United States. Dr. Goh unpacks the overarching themes her team uncovered — racism, discrimination, and critical unmet educational needs — and translates that evidence into actionable strategies for building stronger, more trusting patient-provider relationships. We have a candid conversation about confronting the historical roots of midwifery and obstetrics, and what it truly means to provide care grounded in respect, safety, and bodily autonomy for every birthing person. Dr. Goh also shares the Beloved Birth 50 by 50 bold vision, which is a national call to action to have 50% of all U.S. births attended by midwives by the year 2050. Key Takeaway:Systemic change begins with local action. When we center the leadership of midwives of color and expand equitable access to birth centers, we move closer to a future where every birthing person feels genuinely safe, respected, and heard. Featured Research:Goh AH, Altman MR, Canty L, Edmonds JK. Communication between pregnant people of color and prenatal care providers in the United States: An integrative review. J Midwifery Womens Health. 2024;69(2):202–223. https://doi.org/10.1111/jmwh.13580 [https://doi.org/10.1111/jmwh.13580]

Weight Bias in Midwifery

Behind every breakthrough in reproductive healthcare, a researcher is asking the right questions. More often than you think, that researcher is a midwife. Welcome to Speaking of Midwives, we are the official podcast of the Journal of Midwifery & Women's Health where our host, Melissa Avery, PhD, CNM, FACNM, FAAN leads conversations about evidence, innovations, and the future of midwifery science. Today, in our debut episode Melissa interviews Heather Bradford, PhD, CNM, FACNM, about weight bias in midwifery. Heather shares how she became interested in this topic and how weight bias affects the way we deliver care. The episode introduces our commitment to honest, unfiltered discussions about birth, reproductive justice, and the future of maternal health. Whether you are an expectant parent, a birth professional, or simply a believer in better care for all, this episode is your invitation to join the conversation as we begin Speaking of Midwives. More about Heather Bradford, PhD, CNM, FACNM * Linkedin - @hmbmidwife * Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, & Neal JL. Weight bias in the perinatal period: An integrative review. Birth. 2025;52(2):189-206. Doi:10.1111/birt.12870 * Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, & Neal JL. Weight bias among certified nurse-midwives and certified midwives: Findings from a national sample. J Midwifery Womens Health. 2024;69(3):333-341. Doi:10.1111/jmwh.13608 * Bradford HM, Puhl RM, Phillippi JC, Dietrich MS, & Neal JL. Implicit and explicit weight bias among midwives: Variations across demographic characteristics. J Midwifery Womens Health. 2024;69(3):342-352. Doi:10.1111/jmwh.13616Olson SM, Muñoz EG, Solis EC, * Bradford HM. Mitigating weight bias in the clinical setting: A new approach to care. J Midwifery Womens Health. 2024;69(2):180-190. doi:10.1111/jmwh.13578 Clip mentioned by Heather during the interview. James Cordon clip ⁠   • James Corden Responds to Bill Maher's Fat ...  ⁠ [https://www.youtube.com/watch?v=Ax1U04c4gaw]