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Midwifery Care of Poor and Vulnerable Women, 1925–2003

Authors

  • Jeanne Raisler CNM, DrPH,

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    • Jeanne Raisler, CNM, DrPH, FACNM, is an Assistant Professor at the University of Michigan School of Nursing, and a Nurse Consultant to HRSA's Global AIDS Program in which she trains nurses and midwives in sub-Saharan Africa in AIDS care and treatment. She is the Chair of the International Section of the ACNM Division of Research.

    • Holly Kennedy, CNM, PhD, FACNM, is an Assistant Professor at the University of California San Francisco and Co-Director of its nurse-midwifery education program. She is the Chair of the ACNM Division of Research.

  • Holly Kennedy CNM, PhD

    Search for more papers by this author
    • Holly Kennedy, CNM, PhD, FACNM, is an Assistant Professor at the University of California San Francisco and Co-Director of its nurse-midwifery education program. She is the Chair of the ACNM Division of Research.


FACNM, University of Michigan School of Nursing, 400 North Ingalls, Room 3320, Ann Arbor, MI 48109–0482. E-mail: jraisler@umich.edu

ABSTRACT

A systematic literature review of research on midwifery care of poor and vulnerable women from 1925 to 2003, which included topics studied, research methods used, and special issues and implications for future research, was performed; 44 studies published between 1955 and 2003 were identified. The majority were retrospective, descriptive studies. Outcomes examined included prenatal care visits, vaginal versus operative births, labor interventions, maternal and neonatal mortality and morbidity, birth weight, and cost-effectiveness. Studies showed that midwives predominantly serve vulnerable women who are young, poor, immigrants, or members of racial and ethnic minorities. Preterm birth prevention is emerging as a midwifery research focus. Health system changes are making it more difficult to provide effective care and counseling to disadvantaged women, especially in managed care settings. Extensive evidence documents excellent outcomes of midwifery care for the poor in urban and rural settings over the past three quarters of a century. Future research should include more intervention studies and use both qualitative and quantitative methods to investigate midwifery processes of care and the process-outcome connection. The research focus should broaden beyond childbirth to include gynecology, family planning, and primary care issues. Health disparities, cultural studies, obstetric interventions, and poor women's experiences of childbirth and midwifery care are important topics for future research.

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