Nancy Jo Reedy

Caution in Antenatal Intervention

We assessed 18 fetuses who harbored a urinary tract malformation that was diagnosed by antenatal sonography. The antenatal diagnosis corresponded to the postnatal diagnosis in 66 per cent of the cases. We review the course of 6 fetuses who had catheters placed percutaneously to drain dilated urinary tracts that were believed to be caused by posterior urethral valves (5) or an obstructed megaureter (1). Only 2 of these fetuses exhibited valves postnatally. No fetus had any recognized benefit from the antenatal intervention. We found that sonography may not readily differentiate fetuses with hydronephrosis with obstruction from those without obstruction. From this experience we conclude that intervention in pregnancies suspected of harboring a fetus with a malformed urinary tract should be done cautiously. Antenatal sonography is useful to identify the fetus with a dilated urinary tract. This identification permits perinatal specialists to be alerted so that preparations for reconstructive surgery in such cases can be made early postpartum.

Nurse-midwifery: yesterday, today, and tomorrow.

This article chronicles the dramatic changes in nurse-midwifery over the last 25 years. Presently, multiple models of midwifery education leading to certification exist, all within a competency-based framework. Accreditation of education programs and the certification process within nurse-midwifery remain examples to others. The consumer demand for certified nurse-midwives continues to rise, spurring the preparation for more professionals. However, the average woman in the United States still does not have access to a certified nurse-midwife/certified midwife for care. Several of the barriers to practice have been dismantled during the last quarter century; however, adequate reimbursement, relationships with various groups, and managed care are among the issues that will challenge midwifery in the new century.

Nurse-midwifery: state of the practice.

Although nurse-midwives care for women of all ages, including adolescents and mature, postmenopausal women, the best available statistics can be found regarding births. Since birth statistics lag because of the nature of compiling data, the latest available statistics for attendants at birth were published in 2003, covering up to 2002. According to the National Center for Health Statistics, there were 307,527 CNM-attended births in the United States in 2002, accounting for 7.6% of all births, and more than 10% of all spontaneous vaginal births. For the 10-year period from 1992 to 2002, CNM-attended births (97% of which took place in hospitals) rose an astonishing 64%.1 More than one third of all babies born in New Mexico are born into the hands of a midwife. However, some states lag far behind in the availability of nurse-midwifery care. Nursemidwives have continued to expand the scope of services provided in their practices with the addition of