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Being Polite to midwivesFrom: Betsy Hyde (elishyde@connix.com)Tue Aug 4 20:01:27 1998
>You guys are too polite to these midwives. >-- >Dr.Shiraz Suleman Dr. Suleman: I would be happy to forward to you, and to any other list members by fax (this midwife can't afford a flat bed scanner), the latest report which was commissioned by the US Center for Disease Control and Prevention, National Center for Health Statistics, and which was recently published in the Journal of Epidemiology and Community Health 1998; 52:310-317 which examined all US births in 1991. Singleton births (35-43 weeks gestation) attended by MDs were compared to similar births attended by CNMs at this gestational age. The abstract states: "After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended birth. Conclusion:National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwifes provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women." The study was controlled for medical, socioeconomic and demographic risk. This article states: "When the sociodemographic characteristics of births are examined, a greater percentage of certified nurse midwife than physician deliveries involve mothers who are at increased risk for poor birth outcomes. A higher proportion of the certified nurse midwife deliveries occur among black women, American Indians, teenagers, women with three or more previous births, unmarried women, those with less than a high school education, and those with late or no prenatal care." When medical risk factors were controlled for "physicians attended a slightly higher proportion of births with abruptio placenta, breech/malpresentation, and fetal distress, while certified nurse midwives attended a slightly higher percentage of births with precipitous labor and premature rupture of membranes." Despite higher sociodemographic risk indices in births attended by CNMs, the outcomes were uniformly better compared to births attended by physicians. This study was merely the latest in a long series of studies (bibliography also available upon request) which demonstrate that care by CNMs is equal to or superior to care provided by MDs. To my knowledge, there is no study which even suggests that midwifery care is inferior to physician care in outcome. As I have stated in previous posts, failure to be familiar with the literature is no excuse for rudeness or demeaning comments on this list. We are all here to learn from each other, and to improve the care to women and children. Fortunately, the majority of list-members are courteous to their midwifery colleagues, and supportive of midwifery care.
-- Betsy Hyde CNM Branford, CT
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