ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90013-2

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90014-0

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTThe early recognition ofelevatedblood pressure in pregnancy is still considered the most critical step in preventing the maternal and perinatal morbidity and mortality associated with preeclampsia–eclampsia. The recognition of hypertension is enhanced by an initial assessment of a woman's risk for developing high blood pressure during pregnancy, correct blood pressure measurement, and early prenatal care. The care of the woman with hypertension preceding a pregnancy or during a previous pregnancy includes not only early prenatal care but also pre‐ or interconceptual care that might minimize the risk of further blood pressure elevation during pregnancy, as well as later in life. Tests to predict preeclampsia, such as the “roll” test and the use of the mean arterial pressure during midpregnancy, have been found to be invalid because of poor predictive validity. Relative increases in blood pressure during pregnancy are also no longer considered diagnostic for preeclampsia, however, consideration of relative increases is still “prudent” in assessing signs and symptoms of this disease. The development of preeclampsia is thought to occur very early in pregnancy as a result of imbalances between vasoconstrictive and vasodilatory factors, probably accompanying implantation and placentation. The use of aspirin to prevent the development of hypertension and preeclampsia is currently being studied because it has been shown to shift the balance toward the metabolism of the vasodilatory prostaglandin, prostacycline. At this time, aspirin is only advised for women at high risk for developing preeclampsia. Calcium may also be a preventative mineral, and a diet that is adequate during pregnancy

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90015-9

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTThis study was designed to assess the impact of selected medical interventions during labor upon cesarean section rates by comparing the maternal and neonatal outcomes of obstetrician‐ and nurse‐midwife‐managed low‐risk private patients. All patients who delivered at Prentice Women's Hospital in Chicago, Illinois, from January 1, 1987 through December 31, 1990 were evaluated for low‐risk criteria to be included in the study. During that time, the nurse‐midwives delivered 573 patients and the obstetricians delivered 12,077 patients. Patients with fetal and maternal complications known to increase the cesarean section rate were eliminated from both groups. Eight percent of the nurse‐midwife patients and 32% of the physician patients were eliminated, leaving 529 nurse‐midwife patients and 8,266 physician patients. These patients were compared for race, parity, age, and birth weight. Information was collected from a perinatal data base and hospital computerized statistics. The rates of cesarean section, administration of oxytocin, analgesia, anesthesia, and infant outcome data were compared by chi‐square analysis. Multiple logistic regression analysis was used to assess factors that predicted cesarean section. Nurse‐midwife‐managed patients had a significantly lower rate of cesarean section (8.5% versus 12.9%;P<.005) and operative vaginal delivery (5.3% versus 17%,P= .0001) than the physician‐managed patients. Epidural anesthesia and oxytocin for induction and augmentation were used significantly more frequently in the physician‐managed patients. Both interventions were associated with an increased rate of cesarean section. Fetal outcomes in the two groups were not statistically different. Women cared for by nurse‐midwives had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with th

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90016-7

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTLack of understanding of the legal concept of vicarious liability may underlie certain barriers to nurse‐midwifery practice. Malpractice insurance surcharges, denial or restrictive limitation of clinical privileges, and physician “supervision” requirements may all be premised, at least in part, upon an assumption that physicians who work with, and hospitals that grant clinical privileges to, nurse‐midwives will automatically be liable for any negligent actions or omissions of CNMs. This article examines the basis for such assumptions and, based upon research into the current case law on this subject, concludes that popular assumptions regarding physician/CNM or hospital/CNM vicarious liability are unfounded. According to the author's research, no reported cases exist to support that assumption. Vicarious liability arises from the relationship between two parties and is imposed solely on the basis of the relationship. An employer is almost always vicariously liable for the negligent actions or omissions of his employee. If a nurse‐midwife is thebona fideemployee of a hospital or physician, the latter will most likely be subject to vicarious liability. Absent of any employment relationship, however, such liability will not necessarily be imposed. Rather, the result will vary depending upon the facts of each case, and each professional's relative degree of fault would be determined upon the basis of his or her own actions. Hospital liability for nonemployee nurse‐midwives who hold clinical privileges should be no different from hospital liability for physician members of its medical staff—that is, in most cases the hospital will not be vicariously liable for the negligence of its nonemployee staff, but will be directly liable for its own negligence if it failed to credential or monitor the performance of its staff members properly. A malpractice surcharge case, and the insurance principles and data that may be derived from that case, are a

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90017-5

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTThe role and functions of nurse‐midwifery are currently being studied by the American College of Nurse‐Midwives Certification Council. The remarks that were included on the comment sheet and comments included on the margins of the survey forms were subjected to content analysis. These narrative data complement the quantitative data derived from the research. They reflect a capsule view of contemporary role conflict in nurse‐midw

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90018-3

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTAs health care technology expands, the challenge of providing information about and access to technology becomes greater and greater. Nurse‐midwives are particularly involved in this challenge because of their role in assisting women to make informed decision

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90019-1

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTThe BirthPlace program in San Diego, California, is an example of a successfully “mainstreamed” alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse‐midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public‐funded, Hispanic population, with certified nurse‐midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family‐centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost‐effectiveness while ensuring family‐centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever‐changing health care system, balancing these issues will remain a constant challenge as we reshape our matern

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90020-5

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

ABSTRACTTwo hundred traditional birth attendants (TBAs) of a community development block of India were interviewed. The majority were age 45 years or above (81%), illiterate (85%), and of low caste (78%). Most (88%) had three or more children. Although 27% had inherited the profession from older female relatives, only 4% have daughters or daughters‐in‐law in the profession. Almost half (48%) had conducted 11 or more deliveries in last year. The TBAs charged more money to deliver a male infant than to deliver a female. The TBA workforce in India appears to be shrinking, possibly because of gradual reduction in family size. Backup support from state maternal health care services is lacking. Existing cadre of TBAs should be involved in primary health care to ensure the survival of the institution ofdais(TBAs) and to ensure the availability of basic maternity services to rural wo

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90021-3

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)90022-1

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY