A Randomized, Controlled Trial of Nurse-Midwifery Care

Authors

  • Sheila Harvey RM, MN,

    Corresponding author
    1. Sheila Harvey is Coordinator, Nurse-Midwifery Programme, Foothills Hospital, Calgary; John Jarrell is Chief Medical Officer, Calgary Regional Health Authority, Calgary; Rollin Brant, is Associate Professor, Department of Community Health Sciences, University of Calgary; Colleen Stainton is Professor; Faculty of Nursing, University of Calgary; and Diane Rach is Project Director, Nurse-Midwifery Research Project, Foothills Hospital, Calgary, Alberta, Canada.
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  • John Jarrell MD, FRCSC,

    1. Sheila Harvey is Coordinator, Nurse-Midwifery Programme, Foothills Hospital, Calgary; John Jarrell is Chief Medical Officer, Calgary Regional Health Authority, Calgary; Rollin Brant, is Associate Professor, Department of Community Health Sciences, University of Calgary; Colleen Stainton is Professor; Faculty of Nursing, University of Calgary; and Diane Rach is Project Director, Nurse-Midwifery Research Project, Foothills Hospital, Calgary, Alberta, Canada.
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  • Rollin Brant MMath, PhD,

    1. Sheila Harvey is Coordinator, Nurse-Midwifery Programme, Foothills Hospital, Calgary; John Jarrell is Chief Medical Officer, Calgary Regional Health Authority, Calgary; Rollin Brant, is Associate Professor, Department of Community Health Sciences, University of Calgary; Colleen Stainton is Professor; Faculty of Nursing, University of Calgary; and Diane Rach is Project Director, Nurse-Midwifery Research Project, Foothills Hospital, Calgary, Alberta, Canada.
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  • Colleen Stainton RN, DNSc,

    1. Sheila Harvey is Coordinator, Nurse-Midwifery Programme, Foothills Hospital, Calgary; John Jarrell is Chief Medical Officer, Calgary Regional Health Authority, Calgary; Rollin Brant, is Associate Professor, Department of Community Health Sciences, University of Calgary; Colleen Stainton is Professor; Faculty of Nursing, University of Calgary; and Diane Rach is Project Director, Nurse-Midwifery Research Project, Foothills Hospital, Calgary, Alberta, Canada.
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  • Diane Rach RN, MN

    1. Sheila Harvey is Coordinator, Nurse-Midwifery Programme, Foothills Hospital, Calgary; John Jarrell is Chief Medical Officer, Calgary Regional Health Authority, Calgary; Rollin Brant, is Associate Professor, Department of Community Health Sciences, University of Calgary; Colleen Stainton is Professor; Faculty of Nursing, University of Calgary; and Diane Rach is Project Director, Nurse-Midwifery Research Project, Foothills Hospital, Calgary, Alberta, Canada.
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  • This research was supported by grants from the Alberta Foundation for Nursing Research and the Alberta Association of Registered Nurses. Funding for the Nurse-Midwifery Programme was from the Job Enhancement Advisory Committee, Alberta Health.

Address correspondence to Sheila Harvey, RM, MN, Coordinator; Nurse-Midwifery Programme, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.

Abstract

ABSTRACT: Background: In 1990 a pilot nurse-midwifery program was implemented in a tertiary care hospital in a major western Canadian city. A randomized, controlled trial was conducted to determine if when maternal and newborn patient outcomes were compared, the midwifery program was as effective as traditional, low-risk health care available in the city. Methods: All low-risk women who requested and qualified for nurse-midwifery care were randomly assigned to an experimental or control group. Results: One hundred one women received care from nurse-midwives and 93 received standard care from either an obstetrician or family physician. The rate of cesarean delivery in the nurse-midwife group was 4 percent compared with 15.1 percent in the physician group. The episiotomy rate, excluding cesarean deliveries, for the nurse-midwife group was 15.5percent compared with 32.9 percent in the physician group. The rates of epidural anesthesia for pain relief in labor were 12.9 percent and 23.7 percent, respectively. Statistically significant differences were found for ultrasound examinations, amniotomy, intravenous drug administration during labor; dietary supplements, length of hospital stay, and admission of infants to the neonatal intensive care unit. Conclusions: The results clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars.

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