Anne Scupholme

Nurse-midwifery care to vulnerable populations: Phase I: Demographic characteristics of the National CNM sample

The purpose of this article is to describe the extent to which certified nurse-midwives (CNMs) provide care to vulnerable populations in the United States and the source of reimbursement for this care. The data were obtained from the first phase of a national study to address the characteristics of women served and cost of care provided by CNMs. Results were analyzed nationally and by American College of Nurse-Midwives regions. Certified nurse-midwives in all types of practices are providing care to women from populations that are vulnerable to poorer than average outcomes of childbirth because of age, socioeconomic status, refugee status, and ethnicity. Ninety-nine percent of CNMs report serving at least one group of vulnerable women, and CNMs in the inner city and rural practices serve several groups. The vast majority of CNMs are salaried; only 11% receive their primary income from fee-for-service. Fifty percent of the payment for CNM services is from Medicaid and government-subsidized sources whereas less than 20% comes from private insurance. Source of income varies by type of setting in which the CNM attends births. The results suggest that CNMs, as a group, make a major contribution to the care of vulnerable populations.

Postpartum early discharge: An inner city experience

Nurse-midwives collaborated with obstetricians, pediatricians, nurses and hospital administrators of a large tertiary care center to develop and establish a program for the discharge of low-risk mothers and babies, 12 hours postpartum. The idea was to establish a family-centered alternative to home delivery. Home visits were made each day for 2–3 days by a nurse-midwife/OB visiting nurse team. The baby is seen in a clinic 7–10 days later. At the end of the first year the program safety, acceptability, and cost containment factors were evaluated prior to expansion of the program. The results indicated that early discharge is providing great satisfaction for clients, reduces the cost of perinatal care while improving the quality of care for low-risk families and improves the utilization of available hospital beds.

Are outcomes compromised when mothers are assigned to birth centers for care

A free-standing birth center was established in association with a tertiary care hospital that primarily served an indigent population. Initially, all patient assignments were voluntary. Fifteen months later, a change in policy occurred. In order to reduce the overcrowding in the obstetric suite, the hospital assigned low-risk women to the birth center for maternity care. A study was designed to test the null hypothesis that there would be no difference in outcomes between those who were assigned to the center and those who selected the center for care. One hundred forty-eight women from each group were matched for parity and demographic variables. The outcome results were analyzed and no differences in outcomes were found. The implications for the future of health care for low-risk women of poor socioeconomic status are discussed.

A Comparison Of Visits And Practices Of Nurse‐Midwives And Obstetrician‐Gynecologists In Ambulatory Care Settings

With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to womens health care in the United States. The objective of this study was to describe ambulatory visits and practices of CNMs, and compare them with those of obstetrician-gynecologists (OB/GYNs). Sources of population-based data used to compare characteristics of provider visits were three national surveys of CNMs and two National Ambulatory Medical Care Surveys of physicians. When a subset of 4,305 visits to CNMs in 1991 and 1992 were compared to 5,473 visits to OB/GYNs in similar office-based ambulatory care settings in 1989 and 1990, it was found that a larger proportion of CNM visits were made by women who were publicly insured and below age 25. The majority of visits to CNMs were for maternity care; the majority of visits to OB/GYNs were for gynecologic and/or family planning concerns. Face-to-face visit time was longer for CNMs, and involved more client education or counseling. This population-based comparison suggests that CNMs and OB/GYNs provide ambulatory care for women with diverse demographic characteristics and differing clinical service needs. Enhancing collaborative practice could improve health care access for women, which would be especially beneficial for those who are underserved and vulnerable.

Nurse‐Midwives and Physicians: A Team Approach to Obstetrical Care in a Perinatal Center*

Abstract Controversy exists concerning the role of nurse-midwives in tertiary care centers. By tradition, preparation, and practice, nurse-midwives have not sought to work in the areas of high-risk obstetrics. However with the advent of modem technology and the prevailing economic and legal climate, many more women are finding themselves referred to high-risk centers for obstetrical care. All of these factors contributed to the formation of the nurse-midwifery service at the University of Miami, Jackson Memorial Hospital, Miami, Florida in January 1977. The service is described as it evolved over four and a half years. The success of the model led to the expansion of the philosophy and the development of the three principles of practice-independent management, comanagement, and collaborative management. The nurse-midwives have performed 8,145 deliveries. Selected data is reviewed and the continued role of nurse-midwives in perinatal centers is discussed.

Characteristics of nurse-midwife patients and visits, 1991.

OBJECTIVES This study describes the patient populations served by and visits made to certified nurse-midwives (CNMs) in the United States. METHODS Prospective data on 16,729 visits were collected from 369 CNMs randomly selected from a 1991 population survey. Population estimates were derived from a multistage survey design with probability sampling. RESULTS We estimated that approximately 5.4 million visits were made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity care, although fully 20% were for care outside the maternity cycle. Patients considered vulnerable to poor access or outcomes made 7 of every 10 visits. CONCLUSIONS Nurse-midwives substantially contribute to the health care of women nationwide, especially for vulnerable populations.

Home-based services by nurse-midwives: Sample data from phase II of nurse-midwifery care to vulnerable populations in the United States

This article presents prospective data from Phase II of Nurse-Midwifery Care to Vulnerable Populations in the United States, about home-based health care, including home birth, provided to women and infants by CNMs and the type of practice in which these services are provided. Forty-one certified nurse-midwives collected data on 1,739 client visits, of which 234 occurred in the home. The results indicate that the majority of home visits occur within a practice setting that includes more traditional modes of service and that a proportion of women choose home as the place for health care.This article presents prospective data from Phase II of Nurse-Midwifery Care to Vulnerable Populations in the United States, about home-based health care, including home birth, provided to women and infants by CNMs and the type of practice in which these services are provided. Forty-one certified nurse-midwives collected data on 1,739 client visits, of which 234 occurred in the home. The results indicate that the majority of home visits occur within a practice setting that includes more traditional modes of service and that a proportion of women choose home as the place for health care.

VALIDATING CHANGE IN RISK CRITERIA FOR A BIRTH CENTER: GESTATIONAL DIABETES*

A prospective study of 1300 low risk patients was completed in a birth center to determine the safety of change in screening criteria for gestational diabetes. The incidence of diagnosed gestational diabetes was 2.8% compared to 5% before the change. Of the 36 gestational diabetic patients, 12 (33%), had a normal glucose screen at 28 weeks but were identified after the 32 week screen. Nine (25%) of the diagnosed gestational diabetic patients were under 24 years of age. The incidence of macrosomia was 7.3%, a decrease from 9.5% before implementing change in the screening process. No hypoglycemia was encountered in the babies born at the center. The results of the study indicate that the new screening criteria is safe for the out-of-hospital setting providing that all patients are screened for gestational diabetes.

Puerperal inversion of the uterus: A case report☆

During the first 4 years of the nurse-midwifery service at the University of Miami—Jackson Memorial Medical Center, five cases of puerperal inversion of the uterus were reported. One case is presented and discussed with emphasis on nurse-midwifery management. A review of the literature revealed that, although rare, this phenomenon is more common than generally assumed and nurse-midwives should be familiar with diagnosis and management.

Department Professional affairs exchangeEvaluation survey of the ACNM division of research 1994

Abstract In the summary, we constructed four key themes from the evaluation of the DOR that speak clearly to the directions the DOR needs to take.