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CESAREAN SECTION RATES IN LOW-RISK PRIVATE PATIENTS MANAGED BY CERTIFIED NURSE-MIDWIVES AND OBSTETRICIANS

Authors

  • Lorna G. Davis cnm,

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    • Lorna Davis studied nurse-midwifery and graduated in 1978 with an M.S.N. degree from St. Louis University. She has practiced nurse-midwifery in New York City and most recently served as Assistant Professor of Clinical Obstetrics and Gynecology at Northwestern University Medical School. Currently, she is in a full-scope private nurse-midwifery practice at St. Joseph Hospital in Chicago. She has been Assistant Editor for JNM since 1990.

  • Gayle L. Riedmann cnm,

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    • Gayle L. Riedmann received her master of science degree from UCSF/UCSD Intercampus Graduate Studies in 1986. Most recently, she was a member of a full-scope C.N.M. practice and Assistant Professor of Clinical Obstetrics and Gynecology at Northwestern University Medical School. She is currently involved with legislative efforts to establish freestanding birth centers in the state of Illinois.

  • Melissa Sapiro cnm,

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    • Melissa Sapiro received her master of science degree from the University of Pennsylvania in 1988. Most recently, she was a member of a full-scope C.N.M. practice and Instructor of Clinical Obstetrics and Gynecology at Northwestern University Medical School. She is currently the Director of the Nurse-Midwifery Service at Mount Sinai Hospital in Chicago.

  • John P. Minogue dm,

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    • John P. Minogue most recently served as an Assistant Professor of Clinical Obstetrics and Gynecology at Northwestern University Medical School in the Section of Maternal—Fetal Medicine. He has published and lectured widely in the area of perinatal ethical decision-making. He is currently serving as the tenth President of DePaul University in Chicago.

  • Ralph R. Kazer md

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    • Ralph R. Kazer is an Assistant Professor of Obstetrics and Gynecology at the Northwestern University Medical School. Following his residency in obstetrics and gynecology at Tufts University in Boston, he completed a fellowship in reproductive endocrinology and infertility at University of California, San Diego, in 1986. He currently serves as the Head of the Section of Reproductive Endocrinology and Infertility at Northwestern.


Lorna Davis, CNM, 2600 North Lake View, Suite 4F, Chicago, IL 60614.

ABSTRACT

This study was designed to assess the impact of selected medical interventions during labor upon cesarean section rates by comparing the maternal and neonatal outcomes of obstetrician- and nurse-midwife-managed low-risk private patients. All patients who delivered at Prentice Women's Hospital in Chicago, Illinois, from January 1, 1987 through December 31, 1990 were evaluated for low-risk criteria to be included in the study. During that time, the nurse-midwives delivered 573 patients and the obstetricians delivered 12,077 patients. Patients with fetal and maternal complications known to increase the cesarean section rate were eliminated from both groups. Eight percent of the nurse-midwife patients and 32% of the physician patients were eliminated, leaving 529 nurse-midwife patients and 8,266 physician patients. These patients were compared for race, parity, age, and birth weight. Information was collected from a perinatal data base and hospital computerized statistics. The rates of cesarean section, administration of oxytocin, analgesia, anesthesia, and infant outcome data were compared by chi-square analysis. Multiple logistic regression analysis was used to assess factors that predicted cesarean section. Nurse-midwife-managed patients had a significantly lower rate of cesarean section (8.5% versus 12.9%; P < .005) and operative vaginal delivery (5.3% versus 17%, P = .0001) than the physician-managed patients. Epidural anesthesia and oxytocin for induction and augmentation were used significantly more frequently in the physician-managed patients. Both interventions were associated with an increased rate of cesarean section. Fetal outcomes in the two groups were not statistically different. Women cared for by nurse-midwives had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with those cared for by physicians.

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