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INVESTIGATION OF INSTITUTIONAL DIFFERENCES IN PRIMARY CESAREAN BIRTH RATES

Authors

  • Gigliola Baruffi MD, MPH,

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    • Gigliola Baruffi, MD, MPH, obtained her medical degree at Milan University and her M.P.H. at the Johns Hopkins School of Hygiene and Public Health (JHSHPH). She is presently associate professor and director of the maternal and child health program at the University of Hawaii, School of Public Health. She was on the faculty in maternal and child health at JHSHPH when the data for the current study were collected. Her research interests focus on perinatal health issues, specifically the costs and benefits of alternative maternity care.

  • M. Strobino MDonna PhD,

    Corresponding author
      The Johns Hopkins University School of Hygiene and Public Health, Maternal and Child Health Department, 624 N. Broadway, Baltimore, MD 21205.
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    • Donna M. Strobino, PhD, received her PhD. in demography from Johns Hopkins University and is presently an associate professor in maternal and child health at the Johns Hopkins School of Hygiene and Public Health. Her research interests include evaluation of perinatal programs and services, development of measures of morbidity in the mother and newborn, and the impacts of life-style and demographic factors on pregnancy outcomes.

  • L Paine Lisa CNM, DrPH

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    • Lisa L. Paine, CNM, DrPH, is currently the director of nurse-midwifery services at the Johns Hopkins Hospital. She concurrently 1s an instructor in the School of Medicine and a recent Dr. P.H. graduate from the School of Hygiene and Public Health at the Johns Hopkins University in Baltimore, Maryland. She is also chairperson of the ACNM Division of Research.


The Johns Hopkins University School of Hygiene and Public Health, Maternal and Child Health Department, 624 N. Broadway, Baltimore, MD 21205.

ABSTRACT

Differences in primary cesarean birth rates between a maternity center staffed by certified nurse-midwives (CNM) with physician backup on the premises and a university teaching hospital staffed by resident and attending physicians were studied. The study sample included 796 and 804 women, similar in demographics, who received their prenatal and intrapartum care in the respective sites in 1977 and 1978. Study results indicate a significantly lower rate of primary cesarean birth at the maternity center than at the university hospital that was independent of institutional differences in the indications for abdominal delivery. Although cesarean birth was related to contracted pelvis (at labor), fetal malepresentation, and placental bleeding at both institutions, it was significantly associated with preeclampsia, primiparity, fetal distress, and maternal age only at the university hospital. There were no noteworthy differences in pregnancy outcomes for women delivered vaginally or by cesarean, except for more newborns with low Apgar scores among primary cesarean births at the university hospital A likely explanation for these findings is differing labor and delivery management styles between the providers of care at the two institutions.

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