Sadler Lynn C, McAra-Couper Judith, Pittam Deborah, Wise Michelle R, Thompson John M D
Women's Health, Auckland District Health Board, Auckland, New Zealand.
Department of Epidemiology and Biostatistics, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.
BMJ Open. 2018 Apr 7;8(4):e019026. doi: 10.1136/bmjopen-2017-019026.
To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice.
Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression.
New Zealand.
Women under community LMC midwifery care birthing 2008-2014.
Perinatal mortality (stillbirths and neonatal deaths of babies born from 20 weeks' gestation to the 27th day of postnatal life), excluding terminations and deaths associated with congenital abnormalities.
There were 2045 deaths among 344 910 births booked with midwives.First year of practice midwives cared for women with higher risk of perinatal mortality, including Māori, Pacific, Indian, <20-year-old mothers, nullipara, smokers, women living in socioeconomic deprivation and with high body mass index, than midwives beyond first year of practice.There was a significant reduction in unadjusted odds of perinatal mortality among women under the care of midwives beyond the first year compared with those within the first year (OR 0.79, 95% CI 0.67 to 0.93) but no significant reduction in risk remained after adjusting for known risk factors, (OR 0.89, 95% CI 0.74 to 1.07).There was a significant increase in the adjusted odds of perinatal mortality among midwives booking a caseload of 15 or fewer mothers per year (1.34, 1.01 to 1.78) and 16 to 30 (1.25, 1.04 to 1.50) compared with midwives booking 51 to 80.
Findings suggest that the first year of midwifery practice is not associated with an increased risk of perinatal mortality but there is evidence that early career midwives are caring for higher-risk women. These findings suggest inequity of access for higher-risk women to experienced midwives and highlight an opportunity to improve support for vulnerable women and new midwives.
确定与社区首席产妇护理人员（LMC）助产士执业后期相比，其在执业第一年护理的产妇围产期死亡风险是否增加。
利用全国性的产妇、死亡率和劳动力相关数据进行的回顾性队列研究；采用逻辑回归进行调整分析。
新西兰。
2008 - 2014年接受社区LMC助产士护理分娩的妇女。
围产期死亡率（妊娠20周起至出生后第27天内的死产和新生儿死亡），不包括终止妊娠及与先天性异常相关的死亡。
在助产士护理的344910例分娩中有2045例死亡。与执业一年后的助产士相比，执业第一年的助产士护理的围产期死亡风险较高的产妇更多，包括毛利人、太平洋岛民、印度人、年龄小于20岁的母亲、初产妇、吸烟者、生活在社会经济贫困地区且体重指数高的妇女。与执业第一年的助产士护理的妇女相比，执业一年后的助产士护理的妇女围产期死亡的未调整比值显著降低（比值比[OR]0.79，95%可信区间[CI]0.67至0.93），但在对已知风险因素进行调整后，风险无显著降低（OR 0.89，95%CI 0.74至1.07）。与每年接收51至80名产妇的助产士相比，每年接收15名或更少产妇（1.34，1.01至1.78）和16至30名产妇（1.25，1.04至1.50）的助产士围产期死亡的调整比值显著增加。
研究结果表明，助产士执业第一年与围产期死亡风险增加无关，但有证据表明早期职业生涯的助产士护理的是风险较高的妇女。这些发现表明，高风险妇女获得经验丰富的助产士护理的机会不平等，并凸显了改善对弱势妇女和新助产士支持的机会。
