Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
University of Maryland School of Nursing, Baltimore, Maryland.
J Midwifery Womens Health. 2020 Jan;65(1):22-32. doi: 10.1111/jmwh.13022. Epub 2019 Aug 28.
Maternal obesity is associated with slow labor progression and unplanned cesarean birth. Midwives use fewer medical interventions during labor, and the women they care for have lower cesarean birth rates, compared with low-risk, matched groups of women cared for by physicians. The primary aim of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Unit-level presence of midwives was analyzed as a representation of a unique set of care practices that exist in settings where midwives work.
A retrospective cohort study was conducted using Consortium on Safe Labor data from low-risk, healthy women who labored and gave birth in medical centers with (n = 9795) or without (n = 13,398) the unit-level presence of midwives. Regression models were used to evaluate for associations between unit-level midwifery presence and 1) the incidence of unplanned cesarean birth and 2) in-hospital labor durations with stratification by maternal BMI and adjustment for maternal demographic and pregnancy factors.
The odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women at who gave birth at centers without midwives (adjusted odds ratio, 0.84; 95% CI, 0.77-0.93). However, women whose BMI was above 35.00 kg/m at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. In-hospital labor duration prior to unplanned cesarean was no different by unit-level midwifery presence in nulliparous women whose BMI was above 35.00 kg/m .
Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.
母体肥胖与产程进展缓慢和计划外剖宫产有关。与低风险、由医生照顾的匹配组妇女相比，助产士在分娩期间使用的医疗干预措施较少，且照顾的妇女剖宫产率较低。本研究的主要目的是检查不同 BMI 范围的妇女中，助产士单位级别的存在与计划外剖宫产之间的关联。助产士单位级别的存在被分析为在助产士工作的环境中存在的一套独特的护理实践的代表。
使用安全分娩联盟（Consortium on Safe Labor）的数据，对在有（n=9795）或没有（n=13398）助产士单位级别的医疗中心分娩和分娩的低风险、健康妇女进行回顾性队列研究。使用回归模型评估单位级别的助产士存在与 1）计划外剖宫产的发生率和 2）产妇 BMI 分层和调整产妇人口统计学和妊娠因素后的住院分娩时间之间的关联。
在有助产士的中心分娩的妇女中，计划外剖宫产的几率比在没有助产士的中心分娩的类似妇女低 16%（调整后的优势比，0.84；95%可信区间，0.77-0.93）。然而，在入院时 BMI 超过 35.00 kg/m 的妇女中，无论单位级别的助产士存在与否，她们行剖宫产的几率相似。在 BMI 超过 35.00 kg/m 的初产妇中，在没有计划的剖宫产之前，住院分娩时间在单位级别的助产士存在方面没有差异。
尽管在美国医疗中心的护理环境中整合助产士与剖宫产总体发生率的降低有关，但母体 BMI 的增加仍然与这些结果呈正相关。
