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. 1998 Apr;88(4):675–679. doi: 10.2105/ajph.88.4.675

Evaluation of a public-private certified nurse-midwife maternity program for indigent women.

D Lenaway 1, T D Koepsell 1, T Vaughan 1, G van Belle 1, K Shy 1, F Cruz-Uribe 1
PMCID: PMC1508421  PMID: 9551018

Abstract

OBJECTIVES: This study assessed the impact of a public-private certified nurse-midwife program on prenatal and delivery outcomes among medically indigent women. METHODS: A population-based quasi-experimental design was used to compare 1 intervention county with 2 nonintervention counties. RESULTS: The program significantly reduced the number of women who received no prenatal care and the risk of acquiring less than adequate prenatal care. Reductions in the proportion of infants born premature or with low birth-weights were of borderline significance. The use of induction and/or stimulation of labor was statistically elevated. CONCLUSIONS: These results suggest that the intervention program was instrumental in reducing some, but not all, negative prenatal and delivery outcomes.

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Selected References

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  1. Adams C. J. Nurse-midwifery practice in the United States, 1982 and 1987. Am J Public Health. 1989 Aug;79(8):1038–1039. doi: 10.2105/ajph.79.8.1038. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Akin B. V., Rucker L., Hubbell F. A., Cygan R. W., Waitzkin H. Access to medical care in a medically indigent population. J Gen Intern Med. 1989 May-Jun;4(3):216–220. doi: 10.1007/BF02599526. [DOI] [PubMed] [Google Scholar]
  3. Alexander G. R., Cornely D. A. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med. 1987 Sep-Oct;3(5):243–253. [PubMed] [Google Scholar]
  4. Bazzoli G. J. Health care for the indigent: overview of critical issues. Health Serv Res. 1986 Aug;21(3):353–393. [PMC free article] [PubMed] [Google Scholar]
  5. Browne H. E., Isaacs G. The Frontier Nursing Service: The primary care nurse in the community hospital. Am J Obstet Gynecol. 1976 Jan 1;124(1):14–17. doi: 10.1016/0002-9378(76)90003-x. [DOI] [PubMed] [Google Scholar]
  6. Buescher P. A., Smith C., Holliday J. L., Levine R. H. Source of prenatal care and infant birth weight: the case of a North Carolina county. Am J Obstet Gynecol. 1987 Jan;156(1):204–210. doi: 10.1016/0002-9378(87)90239-0. [DOI] [PubMed] [Google Scholar]
  7. Cornfield J. Randomization by group: a formal analysis. Am J Epidemiol. 1978 Aug;108(2):100–102. doi: 10.1093/oxfordjournals.aje.a112592. [DOI] [PubMed] [Google Scholar]
  8. Davidson E. C., Jr, Gibbs C. E., Chapin J. The challenge of care for the poor and underserved in the United States. An American College of Obstetricians and Gynecologists perspective on access to care for underserved women. Am J Dis Child. 1991 May;145(5):546–549. doi: 10.1001/archpedi.1991.02160050072020. [DOI] [PubMed] [Google Scholar]
  9. Donner A. An empirical study of cluster randomization. Int J Epidemiol. 1982 Sep;11(3):283–286. doi: 10.1093/ije/11.3.283. [DOI] [PubMed] [Google Scholar]
  10. Feldman E., Hurst M. Outcomes and procedures in low risk birth: a comparison of hospital and birth center settings. Birth. 1987 Mar;14(1):18–24. doi: 10.1111/j.1523-536x.1987.tb01444.x. [DOI] [PubMed] [Google Scholar]
  11. Koepsell T. D., Wagner E. H., Cheadle A. C., Patrick D. L., Martin D. C., Diehr P. H., Perrin E. B., Kristal A. R., Allan-Andrilla C. H., Dey L. J. Selected methodological issues in evaluating community-based health promotion and disease prevention programs. Annu Rev Public Health. 1992;13:31–57. doi: 10.1146/annurev.pu.13.050192.000335. [DOI] [PubMed] [Google Scholar]
  12. Kogan M. D., Alexander G. R., Kotelchuck M., Nagey D. A. Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures. JAMA. 1994 May 4;271(17):1340–1345. [PubMed] [Google Scholar]
  13. Levy B. S., Wilkinson F. S., Marine W. M. Reducing neonatal mortality rate with nurse-midwives. Am J Obstet Gynecol. 1971 Jan 1;109(1):50–58. doi: 10.1016/0002-9378(71)90833-7. [DOI] [PubMed] [Google Scholar]
  14. Maldonado G., Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993 Dec 1;138(11):923–936. doi: 10.1093/oxfordjournals.aje.a116813. [DOI] [PubMed] [Google Scholar]
  15. Mullett S. E., Leonard B. J., Oberg C. N., Lia-Hoagberg B. A comparison of birth outcomes by payment source. Minn Med. 1988 Jun;71(6):365–369. [PubMed] [Google Scholar]
  16. Nutter D. O. Medical indigency and the public health care crisis. The need for a definitive solution. N Engl J Med. 1987 Apr 30;316(18):1156–1158. doi: 10.1056/NEJM198704303161813. [DOI] [PubMed] [Google Scholar]
  17. Piper J. M., Mitchel E. F., Jr, Snowden M., Hall C., Adams M., Taylor P. Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records. Am J Epidemiol. 1993 Apr 1;137(7):758–768. doi: 10.1093/oxfordjournals.aje.a116736. [DOI] [PubMed] [Google Scholar]
  18. Piper J. M., Ray W. A., Griffin M. R. Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee. JAMA. 1990 Nov 7;264(17):2219–2223. [PubMed] [Google Scholar]
  19. Reid M. L., Morris J. B. Perinatal care and cost effectiveness: changes in health expenditures and birth outcome following the establishment of a nurse-midwife program. Med Care. 1979 May;17(5):491–500. [PubMed] [Google Scholar]
  20. Rooks J. B., Fischman S. H. American nurse-midwifery practice in 1976-1977: reflections of 50 years of growth and development. Am J Public Health. 1980 Sep;70(9):990–996. doi: 10.2105/ajph.70.9.990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rooks J. P., Weatherby N. L., Ernst E. K., Stapleton S., Rosen D., Rosenfield A. Outcomes of care in birth centers. The National Birth Center Study. N Engl J Med. 1989 Dec 28;321(26):1804–1811. doi: 10.1056/NEJM198912283212606. [DOI] [PubMed] [Google Scholar]
  22. Sable M. R., Stockbauer J. W., Schramm W. F., Land G. H. Differentiating the barriers to adequate prenatal care in Missouri, 1987-88. Public Health Rep. 1990 Nov-Dec;105(6):549–555. [PMC free article] [PubMed] [Google Scholar]
  23. Schwethelm B., Margolis L. H., Miller C., Smith S. Risk status and pregnancy outcome among medicaid recipients. Am J Prev Med. 1989 May-Jun;5(3):157–163. [PubMed] [Google Scholar]
  24. Showstack J. A., Budetti P. P., Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health. 1984 Sep;74(9):1003–1008. doi: 10.2105/ajph.74.9.1003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Slome C., Wetherbee H., Daly M., Christensen K., Meglen M., Thiede H. Effectiveness of certified nurse-midwives. A prospective evaluation study. Am J Obstet Gynecol. 1976 Jan 15;124(2):177–182. doi: 10.1016/s0002-9378(16)33295-1. [DOI] [PubMed] [Google Scholar]
  26. Whiting-O'Keefe Q. E., Henke C., Simborg D. W. Choosing the correct unit of analysis in Medical Care experiments. Med Care. 1984 Dec;22(12):1101–1114. doi: 10.1097/00005650-198412000-00005. [DOI] [PubMed] [Google Scholar]

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