Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing最新文献

Objective: To examine factors associated with cesarean birth by race and ethnicity in a health system with a large proportion of midwife-attended births.

Design: Retrospective cohort study using electronic heath record data.

Setting: A multihospital regional health system of community and academic hospitals on the Colorado Front Range.

Participants: Data from the births of women admitted for labor and birth from January 1, 2018 to January 31, 2020 (N = 10,473).

Methods: We identified cesarean births and categorized them by maternal race and ethnicity and the type of provider who managed the labor. We used descriptive statistics to characterize the sample. We used multivariable logistic regression to examine associations among cesarean birth, maternal race and ethnicity, and provider type accounting for hospital geographic location, maternal age, and insurance status by parity.

Results: Cesareans accounted for 13% of total births and 22.4% of births among nulliparous women with term singleton pregnancies with the fetus in vertex position. Nearly 33% of total births were attended by midwives. Compared with non-Hispanic White women, odds of cesarean birth were significantly higher for nulliparous Black/African American women (odds ratio (OR) = 1.55, 95% confidence interval (CI) [1.13, 2.13], p < .05), Asian women (OR = 1.54, 95% CI [1.02, 2.32], p < .05), Hispanic women (OR = 1.36, 95% CI [1.11, 1.65], p > .05), and women of all other races (OR = 1.70, 95% CI [1.27, 2.27], p < .001) as well as multiparous Hispanic women (OR = 1.60, 95% CI [1.18, 2.25], p < .05) and multiparous women of all other races (OR = 2.60, 95% CI [1.64, 4.13], p < .001). Cesarean birth was more likely when a physician compared with a midwife managed the labor course in nulliparous births (OR = 1.38, 95% CI [1.30, 1.50], p < .001) and multiparous births (OR = 1.60, 95% CI [1.36, 1.90], p < .001).

Conclusion: Although overall rates of cesarean birth were low in comparison with state and national averages, racial disparities persisted. Our study findings are aligned with those from previous studies in which researchers demonstrated lower use of cesarean birth with midwifery care and reinforce the importance of examining multilevel influences on cesarean birth.

Objective: To test the association between Prenatal Care Coordination (PNCC) participation during pregnancy and maternal health outcomes among Medicaid beneficiaries in Wisconsin.

Design: Retrospective cohort study using data from birth records linked to Medicaid claims.

Setting: Wisconsin, United States.

Participants: Beneficiaries with live births funded by Medicaid from 2011 to 2019 (full sample: N = 192,511 births; sibling sample: n = 91,329 births).

Methods: We used conventional and sibling fixed effects (FE) linear probability models to test associations between PNCC (none, assessment/care plan only, or service receipt) and maternal health outcomes, including severe maternal morbidity (SMM), any postpartum visit (within 30 days after birth or within 90 days after birth), emergency department (ED) admission within 30 days after birth, and the Kotelchuck Index of prenatal care adequacy. We adjusted our regression models for demographic, health, and birth characteristics.

Results: In conventional models, PNCC service receipt was positively associated with the likelihood of having a 30-day postpartum visit (7.2 percentage points (pp); 95% confidence interval (CI) [6.5, 7.8pp]), a 90-day postpartum visit (7.1pp; 95% CI [6.5, 7.7pp]), and an ED admission (2.3pp; 95% CI [1.8, 2.7pp]). In bias-limiting sibling FE models, PNCC service receipt was positively associated with having a 30-day postpartum visit (2.6pp; 95% CI [1.4, 3.9pp]) and an ED admission (1.1pp; 95% CI [0.3, 2.0pp]), and it was negatively associated with having SMM (-0.4pp; 95% CI [-0.6, -0.1pp]) and having adequate prenatal care (-1.3pp; 95% CI [-2.2, -0.4pp]).

Conclusion: The mixed evidence regarding the benefit of PNCC indicates the program's potential and opportunities for improvement as well as the need to evaluate similar programs in other states.

Climate change has resulted in increased extreme weather events, including prolonged heat waves, extended wildfire regions and seasons, and more frequent hurricanes and flooding. These events create problems with access to health services, shelter, potable water, diminished air quality, and increased incidence of vector-borne disease that affect the health of pregnant women and families. Nurses caring for pregnant women must have the knowledge to identify and respond to climate change-related health risks. Nursing care related to heat, wildfires and wildfire smoke, hurricanes, and flooding must include accurate assessments and discharge planning that addresses women's health conditions within the context of environmental risks. The purpose of this article is to raise awareness of the clinical nursing care of pregnant women related to heat, wildfires, hurricanes, and flooding in the era of climate change.