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Katy B. Kozhimannil - One of the best experts on this subject based on the ideXlab platform.
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relationship between hospital level percentage of midwife attended births and Obstetric Procedure utilization
Journal of Midwifery & Women's Health, 2018Co-Authors: Laura B. Attanasio, Katy B. KozhimannilAbstract:Introduction Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to Procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and Obstetric Procedure utilization. Methods This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity. Results Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births). Discussion Our results indicate that hospitals with more midwife-attended births have lower utilization of some Obstetric Procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care.
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Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization.
Journal of midwifery & women's health, 2017Co-Authors: Laura B. Attanasio, Katy B. KozhimannilAbstract:Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to Procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and Obstetric Procedure utilization. This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity. Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births). Our results indicate that hospitals with more midwife-attended births have lower utilization of some Obstetric Procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care. © 2017 by the American College of Nurse-Midwives.
Laura B. Attanasio - One of the best experts on this subject based on the ideXlab platform.
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relationship between hospital level percentage of midwife attended births and Obstetric Procedure utilization
Journal of Midwifery & Women's Health, 2018Co-Authors: Laura B. Attanasio, Katy B. KozhimannilAbstract:Introduction Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to Procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and Obstetric Procedure utilization. Methods This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity. Results Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births). Discussion Our results indicate that hospitals with more midwife-attended births have lower utilization of some Obstetric Procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care.
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Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization.
Journal of midwifery & women's health, 2017Co-Authors: Laura B. Attanasio, Katy B. KozhimannilAbstract:Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to Procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and Obstetric Procedure utilization. This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity. Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births). Our results indicate that hospitals with more midwife-attended births have lower utilization of some Obstetric Procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care. © 2017 by the American College of Nurse-Midwives.
Nicholas C. Drew - One of the best experts on this subject based on the ideXlab platform.
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Multidimensional assessment of women's experience of childbirth: relationship to Obstetric Procedure, antenatal preparation and Obstetric history.
Journal of psychosomatic research, 1992Co-Authors: Peter Salmon, Nicholas C. DrewAbstract:Abstract Primiparous postnatal patients ( N = 110) rated their experience of childbirth on a 20-item questionnaire based on an earlier survey of women's spontaneous descriptions. Principal components analysis of the ratings identified three independent dimensions, describing feelings of fulfilment, distress and difficulty, respectively. Ratings by 104 primiparous antenatal patients in the third trimester yielded similar dimensions. The postnatal sample was divided, in turn, according to Obstetric Procedure at delivery, antenatal classes attended, whether the present pregnancy was planned and history of previous termination. Their experience of childbirth was compared on each dimension. Forceps and unassisted deliveries were experienced similarly. Caesarian section was a less difficult, but also less fulfilling and more distressing, experience than either of these. Delivery was less distressing in those who attended antenatal classes, but only one type of class was associated with more fulfilling birth. Finally, delivery was more distressing in women whose pregnancy was unplanned, or in whom a previous pregnancy had been terminated. Future controlled investigations will be incomplete unless each of the three dimensions is measured.
Peter Salmon - One of the best experts on this subject based on the ideXlab platform.
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Multidimensional assessment of women's experience of childbirth: relationship to Obstetric Procedure, antenatal preparation and Obstetric history.
Journal of psychosomatic research, 1992Co-Authors: Peter Salmon, Nicholas C. DrewAbstract:Abstract Primiparous postnatal patients ( N = 110) rated their experience of childbirth on a 20-item questionnaire based on an earlier survey of women's spontaneous descriptions. Principal components analysis of the ratings identified three independent dimensions, describing feelings of fulfilment, distress and difficulty, respectively. Ratings by 104 primiparous antenatal patients in the third trimester yielded similar dimensions. The postnatal sample was divided, in turn, according to Obstetric Procedure at delivery, antenatal classes attended, whether the present pregnancy was planned and history of previous termination. Their experience of childbirth was compared on each dimension. Forceps and unassisted deliveries were experienced similarly. Caesarian section was a less difficult, but also less fulfilling and more distressing, experience than either of these. Delivery was less distressing in those who attended antenatal classes, but only one type of class was associated with more fulfilling birth. Finally, delivery was more distressing in women whose pregnancy was unplanned, or in whom a previous pregnancy had been terminated. Future controlled investigations will be incomplete unless each of the three dimensions is measured.
Antonio Fernandes Moron - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of passage of fetal erythrocytes into maternal circulation after invasive Obstetric Procedures.
The journal of obstetrics and gynaecology research, 2013Co-Authors: D. Meleti, Leandro Gustavo De Oliveira, Edward Araujo Júnior, Ana Carolina Rabachini Caetano, Tatiane Boute, Luciano Marcondes Machado Nardozza, Antonio Fernandes MoronAbstract:Aim The aim of this study was to evaluate the passage of fetal erythrocytes into the maternal circulation after invasive Obstetric Procedures, using the Kleihauer–Betke test, flow cytometry and α-fetoprotein concentration in maternal blood. Material and Methods This was a prospective descriptive study on patients who underwent: amniocentesis, cordocentesis, chorionic villus sample, amniotic infusion, bladder drainage and ventricular–amniotic shunt to investigate the karyotype; treatment for hydrocephalus, oligohydramnios, obstructive uropathy and polyhydramnios; and investigation of lung maturity. Maternal blood samples were collected before and 60 min after the invasive Obstetric Procedure in order to evaluate the passage of fetal erythrocytes using the Kleihauer–Betke test, flow cytometry and α-fetoprotein concentration. Results In total, 43 invasive Obstetric Procedures were performed. The Procedures performed were: 27 cases of amniocentesis (62.7%), seven cases of cordocentesis (16.2%), four chorionic villus samples (9.4%), two amniotic infusions (4.7%), two ventricular–amniotic shunts and one bladder drainage (2.3%). After one case of cordocentesis with two puncture attempts via the placenta, a significant increase in fetal erythrocytes was detected using the three methods. After another cordocentesis with one puncture via the placenta, a significant increase in fetal erythrocytes was detected using flow cytometry and α-fetoprotein concentration, but not through the Kleihauer–Betke test. The other 41 samples did not show any significant increase in fetal erythrocytes in the maternal blood. Conclusion Invasive Obstetric Procedures performed during prenatal care are safe when performed by experienced professionals with the proper technique, with minimal chance of passage of fetal erythrocytes into the maternal compartment.
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Assessment of fetomaternal hemorrhage by Kleihauer-Betke test, flow cytometry and α-fetoprotein after invasive Obstetric Procedures.
Clinical and experimental obstetrics & gynecology, 2012Co-Authors: D. Meleti, Ana Carolina Rabachini Caetano, Luciano Marcondes Machado Nardozza, Boute T, Araujo Júnior E, Antonio Fernandes MoronAbstract:Purpose The aim of this study was to evaluate the passage of fetal red blood cells to the maternal circulation, after invasive Obstetric Procedures, through the Kleihauer-Betke test, flow cytometry and by measurement of maternal serum alpha-fetoprotein level. Methods This prospective descriptive study with patients submitted to amniocentesis, cordocentesis, chorionic villus sampling (CVS), amnioreduction and ventriculoamniotic shunt was performed for karyotype analysis, treatment of hydrocephalus and polyhydramnios and to assess fetal lung maturity. Maternal blood samples were collected before and 60 minutes after the invasive Obstetric Procedure to search for fetal erythrocytes using the Kleihauer-Betke test, flow cytometry and serum alpha-fetoprotein measurement. Results Ten invasive Obstetric Procedures were performed. The mean age of the patients was 29.2 years and the mean gestational age was 29.6 weeks. The Procedures were: five amniocenteses, two cordocenteses, one CVS, one ventriculo-amniotic shunt and one amnioreduction with cephalocentesis. The indications for the Procedures were: karyotype analysis in five patients, fetal lung maturity assessment in two patients, amnioreduction in one patient, fetal hydrocephalus shunt in one patient and polyhydramnios related to hydranencephaly in one patient. Regarding the path of puncture, three Procedures were accomplished through the placenta and seven apart from it. All punctures were successful at the first attempt. There was no significant increase of fetal erythrocyte quantity in maternal blood samples using the Kleihauer-Betke test. After cordocentesis, a significant increase of fetal erythrocytes was detected by flow cytometry and serum alpha-fetoprotein measurement. Conclusion Invasive Obstetric Procedures during prenatal care are safe when performed by experienced professionals using adequate techniques, with minimal chance of passage of fetal erythrocytes from the fetal compartment.
