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.     

Follow-up of the use of local health department clinics for preventive care among young children.

We followed 18,490 infants from their first visit to a county child health clinic (CHC) in Maryland through visits through their third year of age to investigate whether their continued use of the CHCs was related to their characteristics or to the services they were provided as an infant. We classified as provided services immunization, an Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) recommended screening, and number of visits. Immunization was associated with an increased percentage of infants who returned to the CHCs at two and three years of age. Half of the children, on the other hand, never returned to the clinics if they were not immunized as infants. These findings persisted, regardless of race, Medicaid status, completion of a screening, or number of visits in the first year of life. One-fifth of infants did not receive an immunization during one or more visits to CHCs in their first year. Failure to administer an immunization to infants appears to impede subsequent use of public health clinics for well child care.     

Strengthening the Evidence for Maternal and Child Health: Implementing the New Performance Measurement Framework for the Title V Maternal and Child Health Block Grant

Maternal and Child Health Journal - The Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) developed a three-tiered performance measure framework for...     

Preconception Health Promotion Among Maryland Women

Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009–2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57–1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51–0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26–0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05–2.89) or diabetes (aOR 2.79, 95 % CI 1.20–6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92–3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16–2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.     

Is There a Healthy Foreign Born Effect for Childhood Obesity in the United States?

Objective of the study was to explore factors associated with early childhood obesity and assess whether having a foreign born mother is protective against childhood obesity. Data sources include 9 months and 4 years parent interviews and direct assessments of possessive children’s weight and height (4 years) or length (9 months) from the Early Childhood Longitudinal Study-Birth Cohort. Subjects were children with anthropometric measures who lived with their mothers (n = 9,700 at 9 months and 8,200 at 4 years). Overweight is defined as a weight-for-length ratio at or above the 95th percentile at 9 months; obesity is defined as a body mass index at or above the 95th percentile at 4 years. The prevalence of overweight/obesity was 15.4% at 9 months and 18.0% at 4 years. After adjustment for potential confounders, having a foreign-born mother was not associated with the odds of overweight at 9 months or 4 years. At 9 months and 4 years, low birth weight, pre-pregnancy weight and weight gain during pregnancy were protective of overweight. In addition to these factors, at 4 years, excessive weight gain in the first 9 months was the strongest predictors for obesity. Living in a safe neighborhood and ever having breastfed were protective against obesity. Having a foreign born mother is not protective of early childhood obesity. A focus on health of women prior to conception and on women’s and infants’ health in the perinatal period are key to addressing childhood obesity.     

"Healthy-start": outcome of an intervention to promote a heart healthy diet in preschool children

OBJECTIVE: We evaluated the effects of a preschool nutrition education and food service intervention "Healthy Start," on two-to-five-year-old children in nine Head Start Centers in upstate NY. The primary objective was to reduce the saturated fat (sat-fat) content of preschool meals to <10% daily energy (E) and to reduce consumption of sat-fat by preschoolers to <10% E. METHODS: Six centers were assigned to the food service intervention and three to control condition. Food service intervention included training workshops for cooks and monthly site visits to review progress towards goals. Child dietary intake at preschool was assessed by direct observation and plate waste measurement. Dietary intake at home was assessed by parental food record and telephone interviews. Dietary data were collected each Fall/Spring over two years, including five days of menus and recipes from each center. Dietary data were analyzed with the Minnesota NDS software. RESULTS: Consumption of saturated fat from school meals decreased significantly from 1.0%E to 10.4%E after one year of intervention and to 8.0%E after the second year, compared with an increase of 10.2% to 13.0% to 11.4%E, respectively, for control schools (p < 0.001). Total caloric intake was adequately maintained for both groups. Analysis of preschool menus and recipes over the two-year period of intervention showed a significant decrease in sat-fat content in intervention preschools (from 12.5 at baseline to 8.0%E compared with a change of 12.1%E to >11.6%E in control preschools (p < 0.001)). Total fat content of menus also decreased significantly in intervention schools (31.0% to >25.0%E) compared with controls (29.9% to >28.4%E). CONCLUSIONS: The Healthy Start food service intervention was effective in reducing the fat and saturated fat content of preschool meals and reducing children's consumption of saturated fat at preschool without compromising energy intake or intake of essential nutrients. These goals are consistent with current U.S Dietary Guidelines for children older than two years of age.     

Intrapartum oxytocin use for labor acceleration in rural India

Objective: To examine factors associated with the use of oxytocin for acceleration of labor in women delivered at home in rural India. Method: Quantitative data were collected from 527 women who were delivered at home and qualitative interviews were carried out with 21 mothers and 9 birth attendants. Results: Oxytocin use was associated with higher education and socioeconomic status, primigravidity, and delivery by a traditional birth attendant. Conclusion: Labor acceleration with oxytocin occurs indiscriminately In India. Oxytocin use should be regulated, and training for birth attendants should be provided as well as health education for pregnant women.     

Chemical and physical exposures of parents: effects on human reproduction and offspring

The effect of maternal smoking during pregnancy on birth weight was studied in 12,068 births, the mothers in 1819 of which were regarded as smokers. The children of the smokers were compared with those of controls of similar age, parity, marital status and place of residence. Maternal smoking reduced birth weight in a dose-related manner. Birth weight was least affected among young, primiparous mothers who smoked only slightly, a difference which was, however, entirely caused by those mothers who stopped smoking for the last 3 mth of pregnancy, and this subgroup showed similar figures for postneonatal mortality and morbidity up to the age of 5 to those of their controls. Postneonatal mortality was higher in the total group of the smokers than among their controls, the primiparous or young mothers not differing in this respect from the others. Morbidity up to the age of 5 was significantly higher (P< 0.001) among the children of the smokers, the children of the primiparas and young mothers being affected in a similar way to the others. The low birth weight infants of the smokers had a higher mean birth weight and lower perinatal mortality than the low birth weight infants of the controls, but morbidity up to age of 5 and postneonatal mortality were higher among the smokers in respect of both low birth weight infants and others.     

Annual summary of vital statistics--2003

The crude birth rate rose slightly in 2003 to 14.1 births per 1000 population, from 13.9 in 2002. The 2002 rate was the lowest ever reported for the United States. The total number of births and the fertility rate (66.1) also increased. The birth rate for teenaged mothers dropped 3% to another record low in 2003, to 41.7 per 1000 females aged 15 to 19 years. The teenage birth rate has fallen by one third since 1991. The birth rate declined for women 20 to 24 years old but rose for women aged 25 to 44 years. The number, rate, and proportion of births to unmarried women all increased in 2003. Smoking during pregnancy declined to 11%, down from 19.5% in 1989. Prenatal care utilization improved slightly for 2003; 84.1% of women began care in the first trimester of pregnancy. The cesarean delivery rate jumped 6% to 27.6% for another US high. The primary cesarean rate rose 6%, and the rate of vaginal birth after a previous cesarean delivery plummeted 16% from 2002 to 2003. The percent of infants delivered preterm continued to rise (12.3% in 2003). The preterm birth rate is up 16% since 1990. The percentage of children born at low birth weight rose slightly in 2003 to the highest level reported since 1970 (7.9%). The twinning rate increased, but the rate for triplet/+ births declined slightly between 2001 and 2002. Multiple births accounted for 3.3% of all births in 2002. The infant mortality rate rose to 7.0/1000 live births in 2002 from 6.8 in 2001, marking the first increase in this rate in >4 decades. Increases were distributed fairly widely across age, racial/ethnic groups, and geographic areas. The rise in infant mortality was attributed to increases in <750-g births in both singleton and multiple deliveries. Although the downward trend in infant mortality rates in many developed nations may have stabilized, the United States still ranked 27th among these nations in 2001. Expectation of life at birth reached a record high of 77.3 years for all gender and race groups combined in 2002. Death rates in the United States continue to decline. Between 2001 and 2002, death rates declined for the 3 leading causes of death: diseases of heart, malignant neoplasms, and cerebrovascular diseases. Death rates for children 1 to 19 years old decreased by 8% for suicide; the death rate for chronic lower respiratory diseases increased by 33% in 2002. Rates for unintentional injuries and homicide did not change significantly for children aged 1 to 19 years. A large proportion of childhood deaths continues to occur as a result of preventable injuries.     

Validity of maternal report of acute health care use for children younger than 3 years

BACKGROUND: National household surveys often rely on parents' recall to assess children's use of health care services. However, little is known about the accuracy of parental reporting of hospitalizations and emergency department (ED) use. OBJECTIVES: To assess the agreement between maternal reported and medical record acute health care data for children younger than 3 years and to determine if agreement between the 2 varies by maternal characteristics. DESIGN AND METHODS: Data were obtained from the national evaluation of the Healthy Steps for Young Children for 2937 families who completed parent interviews at 2 to 4 and 30 to 33 months and whose children's medical records were abstracted. Services assessed included hospitalizations and ED visits since birth (2-4 and 30-33 months) and in the last 12 months (30-33 months). Absolute and beyond chance agreements were calculated. Results were stratified by maternal age (<20, 20-29, or > or =30 years), parity (first-time, second-time, or greater mother), income (<20,000 dollars, 20,000 dollars-49,999 dollars, or > or =50,000 dollars), and the presence or absence of maternal depressive symptoms. RESULTS: Absolute agreement was high for hospitalizations (> or =90%) at both time points. It was high for ED use (>90%) only at 2 to 4 months. Beyond chance agreement was higher for hospitalizations than for ED use at 2 to 4 and 30 to 33 months. Beyond chance agreement declined with increased duration of recall and younger maternal age. No differences were found by other maternal characteristics. CONCLUSIONS: Mothers have good recall for acute health care events during the first 3 years of their children's lives. This finding suggests that mothers are a good source of information regarding children's acute health care use.