Influence of the birth attendant on maternal and neonatal outcomes during normal vaginal delivery: a comparison between midwife and physician management.
ABSTRACT The purpose of this study was to compare the obstetric outcome of low-risk maternity patients attended by certified midwives with that of low-risk maternity patients attended by obstetricians.
Obstetric outcome of 1352 midwife patients was compared with that of 1352 age- and parity-matched physician patients with normal spontaneous vaginal delivery at the Department of Obstetrics and Gynecology of the University Hospital Vienna during the period from January 1997 to July 2002. Our analysis was restricted to a sample of low-risk pregnant women. Women with medical or obstetric risk factors were excluded.
A significant decrease in the use of oxytocin (p=0.0001) was observed in women who selected a midwife as their primary birth attendant compared with women in the physician group. In both groups most women gave birth in a supine position; however, significantly more alternative birth positions were used by midwife patients (p = 0.0001). Concerning perineal trauma, a significantly lower rate of episiotomies (p = 0.0001) and perineal tears of all degrees (p=0.006) were found in midwife patients. When analyzing severe postpartum hemorrhage and postpartum infections, there were no significant differences between the two groups (p > 0.05). Concerning neonatal outcome, there were no significant differences in APGAR score < 7 at 5 minutes (p > 0.05). Our data clearly show the ability of certified midwives to successfully provide prenatal care and delivery to low-risk maternity patients, with neonatal outcomes comparable to those of physician patients. The use of certified midwives supervised by obstetricians may provide the optimum model for perinatal care, particularly for those women who are low-risk maternity patients, leaving physicians free to attend to the high-risk elements of care.
Article: A profile of midwifery in Paraguay[Show abstract] [Hide abstract]
ABSTRACT: Objective The goal of this study was to provide a descriptive profile of midwifery in Paraguay. Design The study involved three components: background research from official documents and key informant interviews to complete questionnaires, qualitative interviews with Paraguayan midwives and obstetricians, and participant observation. Data from official documents and questionnaires were tabulated using descriptive statistics. Individual interviews, and small-group interviews of midwives, student midwives, and obstetricians were conducted in five health departments of Paraguay. Setting The research took place in the capital of Paraguay, Asunción, and four additional health departments: Central, Cordillera, Guira, and Misiones. Participants Twenty- two midwives, nine student midwives, nine obstetricians, and five leaders of professional health organizations in Paraguay participated in this study. Findings Three salient themes were identified throughout the interviews. First was the understanding of the changing role of the midwife in the health system, particularly in and around the capital city of Asunción. Second, midwives and obstetricians both reported that women were not sufficiently prepared for labour and birth during the prenatal period. Limited prenatal education and childbirth classes existed and midwives felt that this was a major barrier to vaginal birth. Finally, access to midwife-provided prenatal care is perceived to be limited. A major barrier to accessing midwifery care for women in the capital is related to the midwives' changing role in practice. Obstetricians are now providing prenatal care more often than they used to, and in some public hospitals they also attend vaginal deliveries. Key Conclusions and Implications Limiting the utilization of midwives may well be a major contributor to the rising rates of caesarean sections. Women are not prepared for labour and birth in the prenatal period, or are scheduled for elective caesarean sections prenatally. Midwives are not fulfilling their potential to prepare women for labour and birth, despite their high-level professional training. Midwives have the potential to improve prenatal preparation for low-intervention birth. This transition in care provision would be a more effective use of human resources for both obstetricians and midwives.Midwifery 01/2013; 30(10). DOI:10.1016/j.midw.2013.10.011 · 1.12 Impact Factor
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ABSTRACT: to identify and compare obstetricians', midwives' and, assistant personnel's attitudes towards Clinical Practice Guidelines (CPG) for normal birth of The National Health System. quantitative methodology using a self-completed questionnaire regarding the recommendations of the CPG for normal birth with two five-point Likert scales that measured the degree of agreement and the level of applicability. a Labour Ward: Catalonia, Spain. a total sample of 96 professionals (obstetricians=32, midwives=44 and assistant personnel=20) answered the questionnaire. midwives and obstetricians often have significantly divergent levels of agreement on key recommendations. Assistant personnel have more similar opinions to midwives', even though they are a more diverse group. Midwives are more in line with the recommendations of CPG for normal birth than obstetricians and assistant personnel. Concerning the applicability, obstetricians showed greater degree of applicability, followed by the other two groups. given that there is divergence in opinion on agreement and applicability between professional groups it is necessary to identify areas of accordance, disagreement or ambiguity of knowledge and practice among all care providers, so that midwives can facilitate normal childbirth in a shared-model unit.Midwifery 08/2013; 30(7). DOI:10.1016/j.midw.2013.07.003 · 1.12 Impact Factor
Wiener klinische Wochenschrift 06/2004; 116(11):347-349. DOI:10.1007/BF03040912 · 0.79 Impact Factor