Hamlin Lynette, Grunwald Lindsay, Sturdivant Rodney X, Koehlmoos Tracey P
Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States.
Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States.
Policy Polit Nurs Pract. 2021 May;22(2):105-113. doi: 10.1177/1527154421994071. Epub 2021 Feb 20.
The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America's largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012-2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, /augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women's health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.
本研究的目的是确定在军事卫生系统（MHS）中由认证助产士（CNM）护理的女性与由医生护理的女性的社会经济和人口特征，并比较不同提供者类型之间的分娩结局。MHS是美国最大且最复杂的医疗保健系统之一。利用军事卫生系统数据存储库，这项回顾性研究调查了2012 - 2014年期间分娩的TRICARE受益人。分析包括围产期服务的患者频率、描述性统计以及按提供者类型进行的逻辑回归分析。为了考虑患者和妊娠风险的差异，计算了高危和一般风险人群的比值比。2012年至2014年共有136,848例分娩，其中30.8%由CNM接生。与由医生接生的女性相比，由CNM接生的低风险女性剖宫产、引产、分娩并发症、产后出血、子宫内膜炎和早产的几率更低，而阴道分娩、剖宫产术后阴道分娩和母乳喂养的几率更高。这些结果对女性健康劳动力的构成具有启示意义。在MHS中，CNM在其最大权限范围内工作，CNM接生的分娩数量几乎是我国平均水平的4倍。作为美国其他系统和高收入国家的一个范例，本研究增加了越来越多的证据，表明当CNM充分发挥其教育水平时，她们能为更多女性提供优质的健康结局。
