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Midwives as Prenatal Care Providers in the United States
Başlık:
Midwives as Prenatal Care Providers in the United States
Yazar:
Loewenberg Weisband, Jiska, author.
ISBN:
9780438091191
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (126 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Alison Norris Committee members: Maria Gallo; Mark Klebanoff; Abigail Shoben.
Özet:
Introduction: Nearly one-third of births in the United States (US) are Cesarean sections (C-sections); more than double the World Health Organization's optimal C-section rate. In addition, vaginal births frequently include various interventions, including labor induction, labor augmentation, and epidural analgesia. Births in the US are also more expensive than in other high-income countries. Despite the copious amounts of money and care involved in births, maternal and neonatal mortality in the US are among the highest in high-income countries. One substantial difference between the US and other high-income countries is the infrequent use of midwives in the US. Our study aimed to assess whether women who used midwives in the US were different from women who used a physician. Second, we examined the progression of care among midwife patients, to understand when women leave midwife care and to assess correlates of transfers of care to a physician. Finally, we compared birth interventions, maternal outcomes and neonatal outcomes of low-risk women who used a midwife for prenatal care and those who used a physician.
Methods: We used the Listening to Mothers III survey to assess the equivalence of women who used a midwife and those who used a physician. We also obtained a retrospective cohort of women who delivered at The Ohio State University Wexner Medical Center (OSUWMC), and had at least one prenatal care appointment in the OSUWMC network. We used logistic regression with Firth's bias correction as necessary to obtain correlates of transfers from midwife to physician care. We assessed risk ratios and odds ratios of birth interventions, maternal outcomes and neonatal outcomes using modified Poisson regression or logistic regression with Firth's bias correction as appropriate.
Results: We found that nationally, women who use a midwife were similar in most aspects to women who used a physician for prenatal care or as a birth attendant. However, the percentage of white and married women was greater among women who used a midwife for prenatal care, and the percentage of women over age 35 was lower among women who used a midwife as a birth attendant. In our second analysis, we found that less than 5% of women transferred to a physician during prenatal care and 21% transferred during delivery. Our final analysis found that women who used a midwife for prenatal care had reduced risks of having a C-section and preterm birth, without increased odds of severe maternal or neonatal outcomes. Midwife patients had a significant increase in excessive bleeding during labor, although the absolute risk was small.
Conclusions: Women who use midwives for prenatal care are similar to those who use physicians. Our findings also indicate that as most women remained in midwife-care throughout their pregnancy and delivery, initiating prenatal care with a midwife is likely to lead to continuity of care for women with low-risk pregnancies. Finally, we found that for women with low-risk pregnancies, midwives provide a safe alternative to physician care, and midwife care is associated with substantially fewer preterm births and C-sections.
Notlar:
School code: 0168
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(686994.1) | 686994-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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