Stewart S D
Department of Sociology, Bowling Green State University, OH, USA.
Fam Plann Perspect. 1998 Sep-Oct;30(5):231-5.
The proportion of American women who use a nurse-midwife rather than an obstetrician to deliver their baby is increasing. Relatively little is known, however, about the determinants of a midwife-assisted birth.
Logistic regression analyses using birth-certificate data on 149,437 Michigan births in 1990 examined the characteristics associated with midwife-attended births.
Women who paid for childbirth with Medicaid were 3.5 times more likely than those paying with private insurance to use a certified nurse-midwife, net of controls for maternal characteristics; this effect varied significantly by race, with Medicaid payment increasing the odds of midwife use threefold among whites and nearly fivefold among nonwhites. The effect of education on midwife use also varied by race: A college education significantly increased the likelihood of midwife use among white women (odds ratio of 2.1), but higher education decreased that probability among nonwhite women (odds ratio of 0.74). Father's education and age, were also significantly associated with the likelihood of a midwife-attended birth; the babies of college-educated fathers had higher odds of being delivered by a nurse-midwife, as did the babies of men in their 30s.
The relationship between socioeconomic status and the use of midwives may not be as straightforward as previously thought. The patients of nurse-midwives are a diverse group whose socioeconomic characteristics and probable reasons for choosing a midwife over a physician vary widely.
在美国，选择由助产士而非产科医生接生的女性比例正在上升。然而，对于助产士辅助分娩的决定因素，人们了解得相对较少。
利用1990年密歇根州149,437例出生证明数据进行逻辑回归分析，研究与助产士接生相关的特征。
在控制了产妇特征后，使用医疗补助计划支付分娩费用的女性选择认证助产士的可能性是使用私人保险支付费用的女性的3.5倍；这种影响因种族而异，医疗补助计划支付费用使白人选择助产士的几率增加了三倍，非白人则增加了近五倍。教育程度对选择助产士的影响也因种族而异：大学教育显著增加了白人女性选择助产士的可能性（优势比为2.1），但高等教育降低了非白人女性选择助产士的可能性（优势比为0.74）。父亲的教育程度和年龄也与助产士接生的可能性显著相关；父亲受过大学教育的婴儿由助产士接生的几率更高，30多岁男性的婴儿也是如此。
社会经济地位与助产士使用之间的关系可能不像以前认为的那么简单。助产士的患者群体多样，其社会经济特征以及选择助产士而非医生的可能原因差异很大。
