MacDorman M F, Singh G K
Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.
J Epidemiol Community Health. 1998 May;52(5):310-7. doi: 10.1136/jech.52.5.310.
To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors.
Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors.
United States.
The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991.
After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births.
National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women.
确定与医生接生的婴儿相比，由认证护士助产士接生的婴儿在出生结局和存活率方面是否存在显著差异，以及在控制社会人口统计学和医疗风险因素后，这些差异（如果存在）是否依然存在。
使用逻辑回归模型来检验在控制各种社会和医疗风险因素后，认证护士助产士接生的婴儿与医生接生的婴儿在婴儿、新生儿和新生儿后期死亡率以及低出生体重风险方面的差异。使用普通最小二乘法回归模型来检验在控制相同风险因素后平均出生体重的差异。
美国。
该研究纳入了1991年在美国由医生或认证护士助产士接生的所有妊娠35 - 43周的单胎阴道分娩。
在控制社会和医疗风险因素后，由认证护士助产士接生的婴儿发生婴儿死亡的风险比由医生接生的婴儿低19%，新生儿死亡率低33%，低出生体重婴儿的出生风险低31%。由认证护士助产士接生的婴儿的平均出生体重比由医生接生的婴儿重37克。
全国性数据支持了先前本地研究的结果，即认证护士助产士有出色的出生结局。根据认证护士助产士与医生在产前护理以及分娩护理实践方面的差异对这些结果进行了讨论。认证护士助产士为美国的孕产妇护理提供了一种安全且可行的替代方案，特别是对于低至中度风险的女性。
