THE YOLO COUNTY MIDWIFERY SERVICE

A Descriptive Study of 496 Singleton Birth Outcomes, 1990

Authors

  • Lynn M. Schimmel MS, PCNS,

    Corresponding author
      Perinatal Clinical Nurse Specialist, Women's Health Associates, 635 Anderson Road, Suite 18, Davis, CA 95616
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    • Lynn M. Schimmel, MS, PCNS, has been a women's health nurse practitioner in private practice in Davis, California for 16 years. This study was undertaken as part of her graduate work at University of California, San Francisco

  • Pat Hogan CNM,

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    • Pat Hogan, CNM, Barbara Boehler, CNM, Margie DiFelice, PA CM, and Audrey Cooney, CNM, are midwives who comprised the Yolo County Midwifery Service during the year of this study

  • Barbara Boehler CNM,

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    • Pat Hogan, CNM, Barbara Boehler, CNM, Margie DiFelice, PA CM, and Audrey Cooney, CNM, are midwives who comprised the Yolo County Midwifery Service during the year of this study

  • Margie DiFelice PA, CM,

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    • Pat Hogan, CNM, Barbara Boehler, CNM, Margie DiFelice, PA CM, and Audrey Cooney, CNM, are midwives who comprised the Yolo County Midwifery Service during the year of this study

  • Audrey Cooney CNM,

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    • Pat Hogan, CNM, Barbara Boehler, CNM, Margie DiFelice, PA CM, and Audrey Cooney, CNM, are midwives who comprised the Yolo County Midwifery Service during the year of this study

  • Leon D. Schimmel MD

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    • Leon D. Schimmel, MD, an obstetrician-gynecologist in private practice, is founder and medical director of the Yolo County Midwifery Program


Perinatal Clinical Nurse Specialist, Women's Health Associates, 635 Anderson Road, Suite 18, Davis, CA 95616

ABSTRACT

The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 ± 5.5 years, and their mean level of education was 9.9 ± 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken.

Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000.

These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.

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