PROFILE OF TRADITIONAL BIRTH ATTENDANTS IN A RURAL AREA OF NORTH INDIA

Two hundred traditional birth attendants (TBAs) of a community development block of India were interviewed. The majority were age 45 years or above (81%), illiterate (85%), and of low caste (78%). Most (88%) had three or more children. Although 27% had inherited the profession from older female relatives, only 4% have daughters or daughters-in-law in the profession. Almost half (48%) had conducted 11 or more deliveries in last year. The TBAs charged more money to deliver a male infant than to deliver a female. The TBA workforce in India appears to be shrinking, possibly because of gradual reduction in family size. Backup support from state maternal health care services is lacking. Existing cadre of TBAs should be involved in primary health care to ensure the survival of the institution of dais (TBAs) and to ensure the availability of basic maternity services to rural women.     

HOME BIRTH WITH CERTIFIED NURSE-MIDWIFE ATTENDANTS IN THE UNITED STATES

The move of the birth site from home to hospital in the United States from 1800 through the early part of the 20th Century is described. The reemergence of home birth in the United States since the early 1960s and the evolution of nurse-midwifery care in the home birth setting are discussed. Misconceptions regarding home birth and a review of international literature documenting the safety of home birth are included. The need for prospective research on home birth is supported. A Home Birth Curriculum Guide developed by the Home Birth Committee of the American College of Nurse-Midwives is provided.     

HOSPITAL SETTING FOR BIRTH AND USE OF MEDICAL PROCEDURES IN LOW-RISK WOMEN

This study examined the use of selected medical procedures in low-risk women during childbirth. Data from the 1980 National Natality Survey merged with an American Hospital Association annual survey for the same year were used to assess the frequency with which low-risk women in the United States received certain childbirth procedures and to determine whether their use varied by the hospital setting for birth. Stratified analysis was used to assess the relation of hospital level for delivery with the use of electronic fetal monitoring, labor induction, and primary cesarean delivery in low-risk women, with control for potential confounding factors. As the level of available perinatal technology increased, the use of these procedures increased. Results of the study suggest that low-risk women may have received excess interventions and confirm the need for further examination of care procedures for this group.     

USE OF THE NURSE-MIDWIFERY CLINICAL DATA SET FOR CLASSIFICATION OF SUBJECTS IN BIRTH CENTER RESEARCH

Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are safe and have reduced costs for delivery of low-risk women when compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number. Potential inequality of birth center and hospital subjects as to perinatal risk is cited as the major methodologic flaw in the current research on birth centers. Defining an appropriate comparison group is arguably the most important methodologic issue encountered in these investigations. Defining women as “low risk” according to standard perinatal risk tools is not an adequate measure of comparability, as these criteria are generally not equivalent to those defining birth center eligibility. The key is to identify groups for comparison that, at baseline, would be expected to have similar outcomes. To address this concern, a tool based on the American College of Nurse-Midwives'Nurse-Midwifery Clinical Data Set was developed to identify valid comparison subjects for birth center research. This tool focuses on birth center eligibility as opposed to traditionally defined risk. This article reviews the issues of population comparability in birth center research and presents the results of a validation study using this newly developed tool.     

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.     

NURSE-MIDWIVES IN A HOSPITAL BIRTH CENTER

This is a report of the history and development of the Hennepin County Medical Center Nurse-Midwife Service in Minneapolis, Minnesota. Since its inception, the Nurse-Midwife Service has provided care to over 2400 childbearing families. Demographic data, pregnancy outcome, maternal complication, and neonatal morbidity statistics are presented from 496 consecutive singleton births during the period January 1978 to January 1979. Highlights of data include a 4.8% cesarean birth rate for all births from July 1973 to December 1980, and a 6% cesarean rate for 496 births presented in this study. For the 496 consecutive singleton births, 58% of women had no episiotomy or lacerations; 87% of women breastfed their infants; and 97% of infants weighed greater than 2500 g.     

GUIDELINES FOR CLIENT SELECTION IN THE HOME BIRTH MIDWIFERY PRACTICE

Numerous studies have documented the safety of planned home birth; yet, few have identified specific criteria for selection of the home birth candidate. Home birth midwifery practice achieves successful outcomes by appropriate evaluation of medical and obstetric risk factors, as well as an ongoing evaluation and development of the client's psychosocial resources and the midwife-client relationship. Relevant medical and obstetric factors include significant medical illnesses, antenatal course, smoking history, commitment to breastfeeding, and the woman's nutritional profile. Social and environmental factors include the need for a stable birthing environment, practical means for hospital transfer, and the presence of loving support for the client during and after delivery. The client's psychological preparedness is a critical variable that may affect the ability to deliver in the home setting without analgesia or labor augmentation. Active participation in prenatal care, preparation of the home and family members, and a realistic attitude regarding the risks, benefits, and potential complications of planned home delivery are all components of this preparedness. Because midwifery practice promotes midwife-client rapport by careful attention to both medical and psychosocial issues during prenatal care, this relationship is itself an important predictor of the client's suitability for home birth. The quality of midwife-client interactions may influence not only the decision to plan a home birth but the indications for hospital transfer should problems arise. In this article, existing literature is reviewed and criteria are proposed for selecting home birth candidates within the American midwifery practice setting.     

VAGINAL BIRTH AFTER CESAREAN IN A HOSPITAL-BASED BIRTH CENTER STAFFED BY CERTIFIED NURSE-MIDWIVES

The efficacy and safety of a trial of labor after previous cesarean were evaluated in selected, low-risk women in a hospital-based birthing center staffed by certified nurse-midwives. A total of 303 low-risk women with one previous cesarean delivery underwent a trial of labor in the birthing center. A matched control, without a previous uterine incision, was selected for each study patient. Hospital charts of 298 matched pairs were available for analysis. Outcome measures included the requirement for intrapartum transfer to medical management, use of oxytocin, method of delivery, uterine scar separation, Apgar scores, birth weights, maternal febrile morbidity, and length of hospital stay. Intrapartum transfer to medical management was necessary in 26 (8.7%) study patients and 31 (10.4%) control subjects. The overall rate (98.3%) of vaginal birth after cesarean among study patients was not statistically different from the vaginal birth rate (99.3%) among control subjects. There were no differences in maternal or neonatal morbidity. The high percentage (84%) of study patients having had a previous uncomplicated vaginal birth after cesarean must be considered a potential limitation of the outcome data; however, the overall vaginal birth rate between study patients with and study patients without previous vaginal birth after cesarean was not statistically different. The latter group was more likely to require transfer to medical management and/or oxytocin augmentation. On the basis of these results, we concluded that for selected, low-risk patients, a trial of labor after one previous cesarean may be managed safely and effectively by certified nurse-midwives in a hospital setting.     

体外受精供胚移植成功一例报道

本文报道了我国首例经体外受精供胚移植成功的病例。供、受者经应用促排卵药后使排卵周期同步。受者于月经周期第16天,接受供者经体外受精的4细胞、6细胞及两原核阶段胚胎各一个。移植后确定了妊娠,于1988年6月7日诞生了一体重3kg发育正常的男婴。对作为优生工程之一的供胚移植的历史、适应症、成功的因素和应注意事项进行了讨论。