Nethery Elizabeth, Gordon Wendy, Bovbjerg Marit L, Cheyney Melissa
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Department of Midwifery, Bastyr University, Kenmore, WA, USA.
Birth. 2018 Jun;45(2):120-129. doi: 10.1111/birt.12322. Epub 2017 Nov 13.
Approximately 22% of women in the United States live in rural areas with limited access to obstetric care. Despite declines in hospital-based obstetric services in many rural communities, midwifery care at home and in free standing birth centers is available in many rural communities. This study examines maternal and neonatal outcomes among planned home and birth center births attended by midwives, comparing outcomes for rural and nonrural women.
Using the Midwives Alliance of North America Statistics Project 2.0 dataset of 18 723 low-risk, planned home, and birth center births, rural women (n = 3737) were compared to nonrural women. Maternal outcomes included mode of delivery (cesarean and instrumental delivery), blood transfusions, severe events, perineal lacerations, or transfer to hospital and a composite (any of the above). The primary neonatal outcome was a composite of early neonatal intensive care unit or hospital admissions (longer than 1 day), and intrapartum or neonatal deaths. Analysis involved multivariable logistic regression, controlling for sociodemographics, antepartum, and intrapartum risk factors.
Rural women had different risk profiles relative to nonrural women and reduced risk of adverse maternal and neonatal outcomes in bivariable analyses. However, after adjusting for risk factors and confounders, there were no significant differences for a composite of maternal (adjusted odds ratio [aOR] 1.05 [95% confidence interval {CI} 0.93-1.19]) or neonatal (aOR 1.13 [95% CI 0.87-1.46]) outcomes between rural and nonrural pregnancies.
Among this sample of low-risk women who planned midwife-led community births, no increased risk was detected by rural vs nonrural status.
美国约22%的女性生活在农村地区，获得产科护理的机会有限。尽管许多农村社区基于医院的产科服务有所减少，但许多农村社区仍提供家庭助产护理和独立分娩中心护理。本研究调查了由助产士接生的计划在家分娩和在分娩中心分娩的孕产妇和新生儿结局，比较了农村和非农村女性的结局。
使用北美助产士联盟统计项目2.0数据集，该数据集包含18723例低风险、计划在家分娩和在分娩中心分娩的案例，将农村女性（n = 3737）与非农村女性进行比较。孕产妇结局包括分娩方式（剖宫产和器械助产）、输血、严重事件、会阴裂伤或转院以及综合结局（上述任何一种）。主要新生儿结局是早期新生儿重症监护病房或住院（超过1天）以及产时或新生儿死亡的综合情况。分析采用多变量逻辑回归，控制社会人口统计学、产前和产时风险因素。
与非农村女性相比，农村女性具有不同的风险特征，在单变量分析中不良孕产妇和新生儿结局的风险降低。然而，在调整风险因素和混杂因素后，农村和非农村妊娠的孕产妇综合结局（调整后的优势比[aOR]为1.05[95%置信区间{CI}为0.93 - 1.19]）或新生儿综合结局（aOR为1.13[95%CI为0.87 - 1.46]）之间没有显著差异。
在这个计划由助产士主导社区分娩的低风险女性样本中，未发现农村与非农村身份导致风险增加。
