Greulich B, Paine L L, McClain C, Barger M K, Edwards N, Paul R
Nurse-Midwifery Service, Women's Hospital, Los Angeles, CA 90033.
J Nurse Midwifery. 1994 Jul-Aug;39(4):185-96. doi: 10.1016/0091-2182(94)90025-6.
This article describes the setting, policies, practices, and outcomes of the nurse-managed in-hospital birth center at Los Angeles County + University of Southern California Women's Hospital, where women are selected upon admission for birth center care. A retrospective review of available data was made; when compared with hospital records, the primary data source was found to be 96% accurate. Results of the review indicated that from 1981 to 1992, there were 36,410 birth center admissions and 30,311 births, all attended by nurse-midwives; no intrapartum maternal or fetal deaths occurred among all admissions. The intrapartum transfer rate averaged 17%, and declined steadily from a high of 28% in 1982 to a low of 7% in 1990. More in-depth review showed an overall primary cesarean birthrate of 1.8% and an operative birthrate of 4% among the 25,890 admissions and 22,490 births from 1985 to 1992. Detailed postpartum and newborn outcomes from 1982 to 1986 showed a neonatal intensive care unit admission rate of 1.5% and a one-week newborn readmission rate of 1.3% among newborns discharged within 12 to 24 hours; 85% of all newborns returned for follow-up care. This large longitudinal experience demonstrates excellent outcomes that can be achieved when nurse-midwives, working cooperatively with a multidisciplinary health care team, provide in-hospital birth center care to a predominately low-income Hispanic population using a variety of less-traditional intrapartum management techniques. Broader implications for making alternative maternity care services available for low-income women with nurse-midwives and nurses playing a central role are discussed.
本文描述了洛杉矶县+南加州大学妇女医院由护士管理的院内分娩中心的环境、政策、实践和成果，该分娩中心在产妇入院时挑选适合在中心接受护理的女性。对现有数据进行了回顾性分析；与医院记录相比，主要数据源的准确率达96%。分析结果表明，1981年至1992年期间，分娩中心共接收36410名产妇，分娩30311例，均由助产士接生；所有入院产妇中未发生产时孕产妇或胎儿死亡。产时转诊率平均为17%，从1982年的28%的高位稳步下降至1990年的7%的低位。更深入的分析显示，在1985年至1992年的25890例入院产妇和22490例分娩中，总体剖宫产率为1.8%，手术分娩率为4%。1982年至1986年详细的产后和新生儿结局显示，在12至24小时内出院的新生儿中，新生儿重症监护病房入住率为1.5%，一周内新生儿再次入院率为1.3%；85%的新生儿接受了后续护理。这一大型纵向研究经验表明，当助产士与多学科医疗团队合作，运用各种不太传统的产时管理技术，为主要是低收入的西班牙裔人群提供院内分娩中心护理时，可以取得出色的成果。文中还讨论了让低收入女性能够获得替代性产妇护理服务的更广泛意义，其中助产士和护士发挥核心作用。
