Las Vegas School of Nursing, University of Nevada, Las Vegas, Nevada.
J Midwifery Womens Health. 2024 Jan-Feb;69(1):17-24. doi: 10.1111/jmwh.13528. Epub 2023 Jun 24.
This study aimed to identify associations between state policies and access to midwifery care. Identifying policies that facilitate increased access to midwives will help policymakers determine the best methods for increasing access to midwives in their states.
This cross-sectional study was conducted at the county level as a secondary analysis of National Vital Statistics data from the Natality online database. The unit of analysis was counties with populations of at least 100,000, and the outcome was the proportion of births attended by midwives in 2019. The potential predictors of increased access to midwifery care were independent midwife licensure, independent midwife prescribing, midwife access to hospital medical staff membership, and midwife Medicaid parity. Medicaid provider resources and state statutes verified Medicaid reimbursement rates and eligibility for hospital medical staff privileges. Each state was categorized as an independent or restricted licensure state according to data from the American College of Nurse-Midwives. Data for the control variable, the presence of a midwifery education program, were gathered from the Accreditation Commission for Midwifery Education. The analysis was conducted as a Poisson regression.
There was no association between independent licensing and increased access among all states. Stratifying the analysis by independent licensing law revealed that all but one policy was related to higher rates of midwife attendance at birth. Maximum Medicaid reimbursement correlated with greater access regardless of licensing status. The rate of midwife-attended births in independent licensing states grew as the number of potential predictors in a county increased.
Regulatory policies beyond independent licensing are associated with women's access to midwifery services. In independent licensing states, adopting additional policies favorable to midwives may strengthen access to midwifery. Policymakers and regulators can use these findings to identify strategies for accelerating the expansion of midwifery access in their states.
本研究旨在确定州政策与获得助产护理之间的关联。确定促进增加获得助产士机会的政策将有助于政策制定者确定在其州增加获得助产士机会的最佳方法。
本横断面研究在县一级进行，是对国家生命统计数据在线数据库中的出生率数据的二次分析。分析单位是人口至少为 100,000 的县，结果是 2019 年由助产士接生的分娩比例。增加获得助产护理机会的潜在预测因素是独立的助产士执照、独立的助产士处方、助产士获得医院医务人员成员资格以及助产士医疗补助均等化。医疗补助提供者资源和州法规验证了医疗补助报销率和获得医院医务人员特权的资格。根据美国护士助产士学院的数据，每个州都被归类为独立或限制许可州。控制变量（助产士教育计划的存在）的数据来自助产士教育认证委员会。分析采用泊松回归进行。
所有州的独立许可与增加获得之间均无关联。根据独立许可法对分析进行分层，发现除一项政策外，所有政策都与更高的助产士接生率相关。最高医疗补助报销率与更高的获得率相关，无论许可状况如何。独立许可州的助产士接生率随着县内潜在预测因素数量的增加而增长。
独立许可之外的监管政策与妇女获得助产服务的机会有关。在独立许可州，采用对助产士有利的其他政策可能会加强获得助产士的机会。政策制定者和监管机构可以利用这些发现来确定在其州加速扩大助产士机会的策略。
