ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00089-O

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTThe objective of this study was to describe the association between maternal age and selected risk indicators (both recognized and potential) to determine whether any were predictive of labor complications in women having a first child. Low‐risk primigravidas (n= 1,792) were selected from a large national probability sample of births for 1988 (the National Maternal and Infant Health Survey). Recognized and potential risk indicators were described according to categories of maternal age and the occurrence of labor problems. Stratified analysis and logistic regression were used to assess the association of various risk factors with labor complications adjusted for maternal age. Only cesarean delivery varied significantly across maternal age groups, the rate being 11.6% for those<20, 15.9% for those age 20–29, and 28.3% for those ≥ 30. Cesarean delivery was associated with several characteristics of social advantage. Independent risk factors for cesarean delivery were maternal age (particularly ≥ 30), epidural anesthesia, and receipt of adequate prenatal care. We conclude that older primigravidas have significantly more cesarean deliveries, and this is partially explained by characteristics of social advantage. To address the high cesarean rate, care providers need a better understanding of the relationship between social circumstances and cesarean d

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00087-M

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTThis article describes the association among perineal outcomes, selected risk factors, and alternative intrapartum approaches used by nurse‐midwives. This nonrandomized concurrent (cohort) study analyzed all spontaneous vaginal births (N= 1211) attended by nurse‐midwives at a university hospital over a 2‐year period. Univariate analysis was used to calculate relative risks for the associations between two perineal outcomes and selected variables. Study results indicated that parity, ethnicity, birth weight, and use of two techniques (hot compresses and lubrication) were associated with lacerations. The same factors that increase the risk of perineal lacerations also made the performance of an episiotomy more likely; however, for episiotomy, an inverse relationship with perineal hot compresses was noted, and perineal lubrication had no effect. Lack of perineal support was associated with a 66% rise in the risk of episiotomy. Use of birthing positions other than lithotomy significantly reduced the likelihood of episiotomy. The authors concluded that selected care measures to protect the perineum may reduce maternal morbidity and simplify intrapartum care. The risks and benefits of alternative strategies commonly used by nurse‐midwives while caring for diverse populations during birth should be further evaluated in large multiethnic popu

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00086-L

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTThe ACNM Certification Council is responsible for determining that the national certification examination in nurse‐midwifery is not biased toward any protected group. Educational programs of nurse‐midwifery have an interest in knowing that their admissions criteria and educational design have validity. Policy makers have an interest in both of these issues. Nine demographic and preadmission factors were investigated to identify their ability to predict performance on the nurse‐midwifery national certification examination. This retrospective analysis included 1,046 candidates who took any one of five criterion‐referenced, modified essay forms of the examination between January 1988 and April 1994. Multiple‐regression analysis revealed that five factors explained 16.2% of the variance in certification examination performance. These factors included age (as age increased, scores decreased slightly), ethnicity (white and Hispanic candidates received higher scores compared with other groups), years of nursing practice prior to nurse‐midwifery education (a slight positive influence for each additional year), highest educational degree obtained (those whose highest degree was the baccalaureate performed slightly better than candidates with no degree and candidates with graduate degrees), and academic level of the nurse‐midwifery education program (certificate, master's, and doctoral level candidates all performed better than candidates from precertification programs; certificate candidates performed slightly better than master's candidates). However, even though these variables contributed to a statistically significant model, the actual degree of predicted difference in scores was of little practical significance. Variables that were not predictive of performance included marital status, U.S. versus foreign education either in nursing or in midwifery, academic level of the registered nursing educational program, and the highest academic de

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00088-N

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTDespite a rapid expansion in the understanding of the incidence and effects of childhood sexual abuse in the mental health disciplines, health care disciplines have only begun to look at the effect of an abuse history on Women's Health. Little is known from research about its influence on a woman's gynecology care or childbearing experience. The literature across disciplines advocates for routine screening for history of childhood sexual abuse. Asking about childhood sexual abuse will benefit women who have been abused and will help build a database from which to gain clinical knowledge about their care. This review presents clinical reasons to screen, discusses barriers and benefits, and emphasizes manageable ways to incorporate asking about childhood sexual abuse into practice.

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00085-K

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTThis pilot study's objective was to determine the effectiveness of postpartum education received by midwifery clients at the University of New Mexico Hospital. The authors of the study randomized 100 women following delivery to two groups. Group one,n= 55, received written postpartum instructions only. Group two,n= 45, received oral instructions by the certified nurse‐midwife in addition to the written instructions. Both groups answered a written questionnaire after the teaching. Analyses were carried out on 100 posttest scores. Mean test scores for group one was 17.9 out of a possible score of 20. Mean score for group two was 18.3. No significant difference was detected between these two mean scores. A 95% confidence interval for the difference between mean scores was −1.9 to 1.1 (P>.05). Reliability of instrument was established via the Kuder‐Richardson formula 21. This conservative estimate of internal consistency yieldedr= .50. The authors found that oral instructions by the certified nurse‐midwife did not significantly increase the knowledge of primiparas as evidenced by posttest results. However, results must be interpreted cautiously for three reasons: low reliability of the instrument, the small difference between groups, and the sample size. The need to determine how best to approach postpartum education is imperative in this era of early hospital discharge. A certified nurse‐midwife's time may be better spent focusing on individual concerns rather than on a set teaching agenda. Alternative opportunities such as postpartum home visits need to be explored as a means of providing support and guidance to ne

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00091-J

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ABSTRACTIron supplementation is an intervention frequently initiated without adequate data collection to identify iron deficiency. The physiologic changes of normal pregnancy result in lowered hemoglobin and hematocrit levels and make these lab values difficult to interpret. Because excess iron intake by healthy women may have harmful sequelae, safe practice requires an individual assessment of iron status.

ISSN:0091-2182    

DOI:10.1016/0091-2182(94)00057-D

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(95)90079-9

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(95)90080-2

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0091-2182    

DOI:10.1016/0091-2182(95)90082-9

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY