Beth Murray-Davis

McMaster University | McMaster · Department of Obstetrics and Gynaecology

Objectives The 2014 Lancet Series on Midwifery developed the Quality of Maternal and Newborn Care (QMNC) framework outlining care needed for all childbearing people and newborns. Furthermore, this was a global call to action to invest in research capacity building. While evidence-informed care is a cornerstone of midwifery practice, there has been...

Introduction Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research wa...

Point of care ultrasound (POCUS) has increasingly been used by midwives worldwide. In 2018, the scope of midwifery care in Ontario was expanded to include POCUS to allow practitioners to provide more comprehensive care. In response to the scope expansion, a new continuing POCUS education course was created in collaboration with faculty and clinicia...

Background Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada’s first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on t...

Objective To determine the impact of prior gestational diabetes mellitus (GDM) on perinatal outcomes in a subsequent GDM pregnancy. Methods This retrospective cohort study included 544 multiparous patients with two consecutive pregnancies between 2012‐2019, where the second (index) pregnancy was affected by GDM. The primary exposure was prior GDM...

Background: In Canada, the decreasing numbers of family physicians and the small number of midwives providing obstetric care have been associated with a decline in access to maternity services. Several studies and policy documents support the development of models to enhance collaboration between midwives and physicians and to expose trainees to th...

Objective: This study explores the family planning counselling that adolescents receive during pregnancy care, with the aim of identifying those factors that make counselling effective or ineffective. Methods: The study population consisted of ten adolescents who had recently given birth and ten health care providers. Adolescents were recruited usi...

Midwifery care is associated with health benefits for disadvantaged groups but continues to be accessed less frequently in Ontario by people who are of lower socio-economic status (SES). We conducted a qualitative descriptive study investigating the work midwives do to make midwifery care accessible to people of low SES and explored the barriers th...

Objective: To describe access to Ontario midwifery care based on socio-economic status.Design: Two retrospective cohort studies.Setting: Ontario, Canada.Participants: (1) All Ontario midwifery billable courses of care discharged between April 1, 2006, and March 31, 2017 (N = 187,009), and (2) all Ontario residents who gave birth (≥ 20 weeks) in Ont...

Increasing access to midwifery care for disadvantaged groups was an explicit goal of the regulation of midwifery in Ontario. However, people of low socio-economic status (SES) remain less likely to receive midwifery care. We conducted a qualitative descriptive study to explore the work midwives do to make midwifery care accessible to people of low...

Introduction Point of Care Ultrasound (POCUS) is used globally in obstetrics to conduct real time bedside ultrasound scans to answer a clinical question, and it may be conducted by a non-sonography healthcare practitioner. The College of Midwives of Ontario expanded the scope of practice in 2018 to allow registered midwives to perform POCUS during...

Background: It can be overwhelming for newly qualified midwives to begin to work independently due to added responsibility and isolation. A support program was introduced in Ontario, Canada in July 2022 to provide educational resources, peer support and opportunities for reflection on clinical decision-making. This study assesses the extent to whic...

Introduction: In 2018, the College of Midwives of Ontario approved a regulation granting midwives with appropriate training to incorporate point-of-care ultrasound (POCUS) into their practice. A POCUS course for practicing midwives included online modules, a two-day workshop, and a clinical practicum. This study evaluates the curriculum in this nov...

Introduction: Pen-pal or peer-to-peer programs involving peer correspondence have been included within health professions education. However, there has been no published program for midwifery students in the literature. The Global Peer-to-Peer (GP2P) Program connected first- and second-year midwifery students in Australia and Canada to foster conve...

Background: Maternal serum markers used for trisomy 21 screening are associated with placenta-mediated complications. Recently, there has been a transition from the traditional first-trimester screening (FTS) that included PAPP-A (pregnancy-associated plasma protein-A) and beta-hCG (human chorionic gonadotropin), to the enhanced FTS test, which ad...

Background Globally, midwifery‐led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife‐led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at...

Objective To estimate the association of advanced maternal age with pregnancy complications in twin pregnancies and compare it with that observed in singleton pregnancies. Methods A population‐based retrospective cohort study of all patients with a singleton or twin hospital birth in Ontario, Canada, between 2012 and 2019. The primary outcome was...

Introduction Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Approaches to screening for GDM continue to evolve, introducing potential variability of care. This study explored the impact of these variations on GDM counselling and screening from the perspectives of pregnant individuals. Methods Following a Corbin...

Background: Canada's first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service user...

Point of care ultrasound (POCUS) has increasingly been used by midwives worldwide. In 2018, the scope of midwifery care in Ontario was expanded to include POCUS to allow practitioners to provide more comprehensive care. In response to the scope expansion, a new continuing POCUS education course was created in collaboration with faculty and clinicia...

Objective Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women’s values and beliefs related to weight, n...

BACKGROUND : Both gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are common, and each are associated with adverse maternal and perinatal outcomes. Midwives may be the first point of care when these conditions arise. This study evaluated the experiences of midwives when providing care to women and people with pregn...

Context The optimal 50g-glucose challenge test (GCT) cut-off for the diagnosis of gestational diabetes (GDM) in twin pregnancies is unknown. Objective To explore the screening accuracy of the 50g-GCT and its correlation with the risk of large for gestational age (LGA) newborn in twin compared to singleton pregnancies. Design Population-based retr...

Aim: - To determine the prognostic value of the antepartum 75g-oral glucose tolerance test (OGTT) for future type 2 diabetes mellitus (T2DM) in nulliparous pregnant women who tested negative for GDM. Methods: - A population-based retrospective cohort study of nulliparous pregnant women who underwent testing for GDM using a 75g-OGTT in Ontario, C...

Objective Globally, midwife-led units are associated with improved clinical outcomes and childbirth satisfaction, but little is known about the impact of the model on health professionals themselves and interprofessional collaboration. The aim of this research was to describe the experiences of health professionals providing care in Canada's first...

Introduction Rates of perinatal cannabis use are rising, despite clinical evidence about the potential for harm. Accordingly, pregnant and lactating people who perceive a benefit from cannabis use may have a difficult time making informed decisions about cannabis use. Methods We conducted a systematic review of mixed‐methods research to synthesize...

Introduction Severe maternal morbidity (SMM)—an unexpected pregnancy-associated maternal outcome resulting in severe illness, prolonged hospitalisation or long-term disability—is recognised by many, as the preferred indicator of the quality of maternity care, especially in high-income countries. Obtaining comprehensive details on events and circums...

Objectives: Cerebro-placental ratio (CPR) is a doppler tool contributes to clinical decision-making in pregnancies affected by small for gestational age weight (SGA). Pregnancies affected by gestational diabetes mellitus (GDM) tend to have higher newborn weight, but greater risk of adverse perinatal outcomes. We hypothesized that in GDM-complicate...

OBJECTIVE The growing prevalence of obesity is a concern for midwives. In Canada, the absence of regulatory standards, varying protocols and consultant preferences shape clinical decision making for the midwife and may lead to inconsistent practice. Our aim was to understand the barriers, enablers, and knowledge gaps that influenced experiences of...

Background Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine “how do perinatal clinicians respond to pr...

Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-re...

Background: People whose singleton pregnancy is affected by hypertensive disorders of pregnancy (HDP) are at risk of future cardiovascular disease. It is unclear, however, whether this association can be extrapolated to twin pregnancies. We aimed to compare the association between HDP and future cardiovascular disease after twin and singleton preg...

Background: In July 2018, Canada's first midwife-led alongside midwifery unit (AMU) opened at Markham Stouffville Hospital (MSH) in Markham, Ontario. Our objectives were to examine how the conditions at MSH made it possible for the hospital to create the first AMU in Canada and to identify lessons to inform spread by examining how characteristics...

Objective: To evaluate whether pregnancy outcomes associated with hypertensive disorders of pregnancy in twin pregnancies differ relatively from those in singleton pregnancy. Methods: We conducted a retrospective, population-based cohort study of all women with a liveborn singleton or twin hospital birth in Ontario, Canada, between 2012 and 2019...

Introduction: Since 2013 various guidelines for hypertension in pregnancy were refined, no longer requiring proteinuria as a requisite for preeclampsia. We aimed to evaluate the impact of the new definition on preterm birth (PTB) and adverse pregnancy outcomes. Methods: Women delivering in Ontario between 4/2012-11/2016 were included. Delivery <...

Objective: To develop twin-specific outcome-based OGTT diagnostic thresholds for GDM based on the risk of future maternal type-2 diabetes. Design: A population-based retrospective cohort study (2007-2017). Setting: Ontario, Canada METHODS: Nulliparous women with a live singleton (N=55,361) or twin (N=1,308) birth who underwent testing for GDM...

Objective: We aimed to quantify the risk of future maternal type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) based on the type and number of abnormal 75-g oral glucose tolerance test (OGTT) values and the diagnostic criteria used for the diagnosis of GDM. Research design and methods: We conducted a population-bas...

Objectives: Gestational weight gain (GWG) is increasingly monitored in the United States and Canada. While promoting healthy GWG offers benefits, there may be costs with over-surveillance. We aimed to explore these costs/benefits. Methods: Quantitative data from 350 pregnant survey respondents and qualitative focus group data from 43 pregnant/po...

Background Data on the optimal gestational weight gain (GWG) in twin pregnancies are limited. As a result, the Institute of Medicine (IOM) currently provides only provisional recommendations on GWG in this population. Objective To identify the optimal range of GWG in twin pregnancies and to estimate the association between inappropriate GWG and ad...

Background: Cannabis use during the perinatal period is rising. Objectives: To synthesize existing knowledge on the perspectives of pregnant people and their partners about cannabis use in pregnancy and lactation. Search strategy: We searched MEDLINE, APA PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Social Science Citation In...

Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g. high-res...

Midwifery care is associated with health benefits for disadvantaged groups but continues to be accessed less frequently in Ontario by people who are of lower socioeconomic status (SES). We conducted a qualitative descriptive study investigating the work midwives do to make midwifery care accessible to people of low SES and explored the barriers the...

Objective: To describe access to Ontario midwifery care based on socioeconomic status (SES). Design: Two retrospective cohort studies. Setting: Ontario, Canada. Participants: 1. All Ontario midwifery billable courses of care discharged between April 1, 2006 and March 31, 2017 (N=187,009). 2. All Ontario residents who gave birth (≥ 20 weeks) in Onta...

Increasing access to midwifery care for disadvantaged groups was an explicit goal of the regulation of midwifery in Ontario. However, people of low socio-economic status (SES) remain less likely to receive midwifery care. We conducted a qualitative descriptive study to explore the work midwives do to make midwifery care accessible to people of low...

Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition...

Objective To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and soc...

Objective To determine the impact of pre-pregnancy diabetes mellitus (D), obesity (O) and chronic hypertension (H) on preterm birth (PTB). Methods Retrospective population-based cohort study in Ontario, Canada between 2012–2016. Women who had a singleton livebirth or stillbirth at > 20 weeks gestation were included in the cohort. Exposures of inte...

Background: Inappropriate gestational weight gain in pregnancy may negatively impact health outcomes for mothers and babies. While optimal gestational weight gain is often not acheived, effective counselling by antenatal health care providers is recommended. It is not known if gestational weight gain counselling practices differ by type of antenat...

Women with twins have an a priori increased risk for many of the complications associated with maternal obesity. Thus, the impact of maternal obesity in twins may differ from that reported in singletons. In addition, given the increased metabolic demands in twin pregnancies, the impact of maternal underweight may be greater in twin compared with si...

Environmental factors affecting development through embryogenesis, pregnancy, and infancy impact health through all subsequent stages of life. Known as the Developmental Origins of Health and Disease (DOHaD) hypothesis, this concept is widely accepted among health and social scientists. However, it is unclear whether DOHaD‐based ideas are reaching...

Objectives Controversy exists about the timing of delivery of women with pre-pregnancy type 1 and 2 diabetes mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward. Research design and methods This was a retrospective populatio...

Background: Despite public funding of midwifery care, people of low-socioeconomic status are less likely to access midwifery care in Ontario, Canada, but little is known about barriers that they experience in accessing midwifery care. The purpose of this study was to examine the barriers and facilitators to accessing midwifery care experienced by...

Objective: Pre-existing diabetes mellitus (D), obesity (O), and chronic hypertension (H) can each alter the natural course of pregnancy, especially when they cluster together. Because the prevalence of various combinations of D, O, and H is unknown, the current study was undertaken. Methods: This population-based cross-sectional study included 5...

Background: Excess gestational weight gain has long- and short-term implications for women and children, and postpartum weight retention is associated with an increased risk of long-term obesity. Despite the existence of dietary and exercise guidelines, many women struggle to return to pre-pregnancy weight. Experiences of women in tackling postpar...

Competency-based education requires that programs increase the breadth of direct observation and assessment to improve resident training. To achieve these goals, the authors developed and executed a multiple-trainee, multiple-level, multiple-competency (Multi-TLC) obstetrical emergencies simulation curriculum. Depending upon their training level (P...

Objectives Universal screening for Gestational diabetes mellitus(GDM) identifies women with varying degrees of glucose intolerance, many of which will achieve glycemic control by lifestyle and nutritional modification alone. The objective of the study was to develop a prediction model based on biochemical, clinical and sonographic parameters to acc...

Midwives in Ontario are integrated into the provincial health-care system, providing primary antenatal, intrapartum, and postpartum care to low-risk women throughout pregnancy and for 6-week postpartum. Midwives are educated through a 4-year direct-entry, university-based Bachelor of Health Science program or, if internationally trained, through a...

Background: The primary aim of this study was to examine weight gain during pregnancy and associated adverse outcomes across different types of antenatal health care providers. Our research question examined whether type of antenatal health care provider (family physician, obstetrician, midwife, or family physician plus obstetrician) was associate...

Pregnancy-related diastasis rectus abdominis (DRA) is a prevalent condition. Consequences of a widened linea alba ultimately remain unknown. Current evidence on conservative management is conflicting, creating debate among practitioners. This study aims at developing a set of expert consensus-based recommendations for the assessment and conservativ...

Background: Among singleton pregnancies, gestational diabetes mellitus is associated with adverse outcomes. In twin pregnancies, this association may be attenuated, given the higher rate of prematurity and the a priori increased risk of some of these complications. Objective: Our aim was to test the hypothesis that gestational diabetes mellitus...

Objective: To assess whether routine induction of labor at 38 or 39 weeks in women with chronic hypertension is associated with the risk of superimposed preeclampsia or cesarean delivery. Methods: We conducted a retrospective population-based study of women with chronic hypertension who had a singleton hospital birth at 38 0/7 weeks of gestation...