Harvey S, Jarrell J, Brant R, Stainton C, Rach D
Birth. 1996 Sep;23(3):128-35. doi: 10.1111/j.1523-536x.1996.tb00473.x.
In 1990 a pilot nurse-midwifery program was implemented in a tertiary care hospital in a major western Canadian city. a randomized, controlled trial was conducted to determine if, when maternal and newborn patient outcomes were compared, the midwifery program was as effective as traditional, low-risk health care available in the city.
All low-risk women who requested and qualified for nurse-midwifery care were randomly assigned to an experimental or control group.
One hundred one women received care from nurse-midwives and 93 received standard care from either an obstetrician or family physician. The rate of cesarean delivery in the nurse-midwife group was 4 percent compared with 15.1 percent in the physician group. The episiotomy rate, excluding cesarean deliveries, for the nurse-midwife group was 15.5 percent compared with 32.9 percent in the physician group. The rates of epidural anesthesia for pain relief in labor were 12.9 percent and 23.7 percent, respectively. Statistically significant differences were found ultrasound examinations, amniotomy, intravenous drug administration during labor, dietary supplements, length of hospital stay, and admission of infants to the neonatal intensive care unit.
The results clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars.
1990年，在加拿大西部一个主要城市的一家三级护理医院实施了一项助产士试点项目。进行了一项随机对照试验，以确定在比较孕产妇和新生儿患者的治疗结果时，该助产士项目是否与该市现有的传统低风险医疗保健一样有效。
所有要求并符合助产士护理条件的低风险女性被随机分配到实验组或对照组。
101名女性接受了助产士的护理，93名女性接受了产科医生或家庭医生的标准护理。助产士组的剖宫产率为4%，而医生组为15.1%。排除剖宫产，助产士组的会阴切开率为15.5%，而医生组为32.9%。分娩时用于缓解疼痛的硬膜外麻醉率分别为12.9%和23.7%。在超声检查、人工破膜、分娩期间静脉用药、膳食补充剂、住院时间以及婴儿入住新生儿重症监护病房方面发现了统计学上的显著差异。
结果明确支持了助产士试点项目的有效性，并表明助产士在加拿大医疗保健系统中更广泛的参与是对医疗保健资金的合理使用。
