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Sorbara C, Ray JG, Darling EK, Chung H, Podolsky S, Stukel TA. Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care. JAMA Netw Open 2024; 7:e248676. [PMID: 38683610 PMCID: PMC11059030 DOI: 10.1001/jamanetworkopen.2024.8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/27/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum. Objective To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care. Design, Setting, and Participants This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023. Exposures Perinatal care clinician, namely, a midwife or obstetrician. Main Outcome and Measures : Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights. Results Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77). Conclusions and Relevance In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.
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Affiliation(s)
- Carla Sorbara
- Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Joel G. Ray
- ICES, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth K. Darling
- ICES, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Matenchuk BA, Rosychuk RJ, Rowe BH, Metcalfe A, Chari R, Crawford S, Jelinski S, Serrano-Lomelin J, Ospina MB. Emergency Department Visits During Pregnancy. Ann Emerg Med 2023; 81:197-208. [PMID: 35940991 DOI: 10.1016/j.annemergmed.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE Pregnant women often seek care in an emergency department (ED). We sought to describe the frequency, characteristics, and factors associated with increased ED visits during pregnancy. METHODS We conducted a retrospective cohort study using administrative health data of all pregnancies resulting in a live birth at 20 or more weeks of gestation in Alberta, Canada, from 2011 to 2017. The primary outcome was the occurrence of any ED visit during pregnancy. The secondary outcomes were ED visit characteristics and discharge disposition. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for associations between sociodemographic and clinical factors and increased ED visits during pregnancy using random-effect negative binomial regression adjusting for multiple pregnancies per person during the study period. RESULTS We included 255,929 pregnancies from 193,965 women. Of all the pregnancy episodes followed, 37.3% (95% CI 37.1 to 37.5) had at least 1 ED visit, resulting in a total of 226,811 ED visits and an overall ED visit rate of 94.0 visits per 100 pregnancies (95% CI 93.6 to 94.3). Most visits were nonobstetric (46.4%) and resulted in ED discharge (85.3%). Increased ED visits were associated with living in remote (RR 6.9; 95 %CI 6.7 to 7.1) or rural (RR 3.4; 95% CI 3.4 to 3.5) areas, younger age (RR 1.9; 95% CI 1.8 to 2.0), intensive prenatal care (RR 1.5; 95% CI 1.5 to 1.5), major/moderate health conditions (RR 1.6; 95% CI 1.6 to 1.6), mental health conditions (RR 1.6; 95% CI 1.5 to 1.6), and high antepartum risk score (RR 1.1; 95% CI 1.1 to 1.1). CONCLUSION Approximately 1 in 3 women in our sample visited the ED during pregnancy. A higher number of visits occurred in those with rural/remote residence, younger maternal age, and concomitant health conditions.
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Affiliation(s)
- Brittany A Matenchuk
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Amy Metcalfe
- Departments of Obstetrics and Gynecology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Susan Jelinski
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Alberta, Canada
| | - Jesus Serrano-Lomelin
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Adeniyi A, Donnelly L, Janssen P, Jevitt C, Kardeh B, von Bergmann H, Brondani M. Pregnant women's perspectives on integrating preventive oral health in prenatal care. BMC Pregnancy Childbirth 2021; 21:271. [PMID: 33794806 PMCID: PMC8016156 DOI: 10.1186/s12884-021-03750-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Oral diseases are considered a silent epidemic including among pregnant women. Given the prevalence of oral conditions among pregnant women and the reported association with adverse pregnancy outcomes, there have been suggestions for the inclusion of preventive oral care in routine prenatal care. However, due to the different administrative and funding structure for oral health and prenatal care in Canada, progress towards this integration has been slow. Our study sought to qualitatively explore the views of pregnant women in British Columbia (BC) on the strategies for integrating preventive oral health care into prenatal care services. METHODS A qualitative approach was utilized involving semi-structured interviews with fourteen (14) purposefully selected pregnant women in Vancouver and Surrey, BC. The interviews were audio-recorded and transcribed. The transcripts were analyzed using an inductive thematic approach. Study validity was ensured via memoing, field-notes, and member checking. RESULTS Interviews ranged from 28 to 65 min producing over 140 pages of transcripts. Analysis resulted in three major themes: oral health experiences during pregnancy, perspectives on integration and integrated prenatal oral care, and strategies for addressing prenatal oral health care. A majority of participants were supportive of integrating preventive oral care in routine prenatal services, with referrals identified as a critical strategy. Oral health education was recognized as important before, during, and after pregnancy; oral health assessments should therefore be included in the prenatal care checklist. Limited funding was acknowledged as a barrier to oral health care access, which may explain why few participants visited their dentists during pregnancy. Interprofessional education surfaced as a bridge to provide prenatal oral health education. CONCLUSION Pregnant women interviewed in this study support the inclusion of educational and preventive oral care during prenatal care, although their views differed on how such inclusion can be achieved in BC. They advocated the establishment of a referral system as an acceptable strategy for providing integrated prenatal oral health care.
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Affiliation(s)
- A Adeniyi
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada.
| | - L Donnelly
- Department of Oral Biological & Medical Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada
| | - P Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - C Jevitt
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - B Kardeh
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - H von Bergmann
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada
| | - M Brondani
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada
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Alyahya MS, Khader YS, Batieha A, Asad M. The quality of maternal-fetal and newborn care services in Jordan: a qualitative focus group study. BMC Health Serv Res 2019; 19:425. [PMID: 31242940 PMCID: PMC6595569 DOI: 10.1186/s12913-019-4232-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/07/2019] [Indexed: 01/06/2023] Open
Abstract
Background The antenatal, intrapartum, and postnatal periods are considered high-risk periods for the health of mothers and their newborns. Although the current utilization rate of some maternal and child care services in Jordan is encouraging, detailed information about the quality of these services is limited. Therefore, this study aimed to explore the quality of maternal-fetal and newborn antenatal care (ANC), delivery, and postnatal care (PNC) services in Jordan. Methods We conducted 12 focus group discussions (FGDs) with pregnant and postpartum women who attended maternal-child care services in three major hospitals in Jordan. All FGDs were recorded and transcribed verbatim. An inductive thematic analysis approach was used to identify themes and subthemes. Results The content analysis of the FGDs revealed a consensus among the discussants regarding the importance of ANC and PNC services for the health of mothers and their newborns. However, the participating women viewed ANC to be much more important than PNC. With regards to the choice between public and private antenatal care services, some of the discussants were disposed towards the private sector. Reasons for this included longer consultation time, a higher quality of services, better interpersonal and communication skills of healthcare providers, better treatment, more advanced equipment and devices, availability of female obstetricians, and more flexible appointment times. These women only perceived public hospital services to be necessary in cases of pregnancy-related complications and labor, as the costs of private sector services in such cases are too high. The findings also revealed that mothers usually only seek PNC services to check up on their newborn’s health and not their own. Conclusion Visiting private ANC clinics throughout pregnancy while giving birth in public facilities leads to the discontinuity and fragmentation in maternal-fetal and child healthcare services. To address this fragmentation, healthcare systems are proposed to establish interprofessional teamwork that requires different healthcare providers with complementary skills and practices in both public and private settings to work co-operatively and collectively. Investment in new technologies and interventions which enhance coordination and collaboration between public and private healthcare settings is necessary for the provision of non-traditional maternal healthcare. Electronic supplementary material The online version of this article (10.1186/s12913-019-4232-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Yousef S Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Anwar Batieha
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Majed Asad
- Jordan Ministry of Health, Directorate of non-communicable diseases, Amman, Jordan
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Premji S, McDonald SW, Zaychkowsky C, Zwicker JD. Supporting healthy pregnancies: Examining variations in nutrition, weight management and substance abuse advice provision by prenatal care providers in Alberta, Canada. A study using the All Our Families cohort. PLoS One 2019; 14:e0210290. [PMID: 30615660 PMCID: PMC6322767 DOI: 10.1371/journal.pone.0210290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pregnancy is a critical time for fetal development, and education of women regarding healthy lifestyle choices is an important function for prenatal care providers, those that provide care to women during pregnancy. Within Canada, women choose to receive pregnancy care from one of a variety of publicly funded care providers. This study examines the association between the type of care provider(s) seen during pregnancy and the provision of advice related to nutrition, weight management and substance abuse. Methods Using data from the Alberta-based All Our Families prospective pregnancy cohort, we conducted bivariate and multivariate analyses to determine the likelihood of receiving advice related to nutrition, weight management, and substance abuse across provider(s) seen. Results Of 3341 women in our sample, 38% saw a single provider during pregnancy and 56% received care from multiple providers. Advice on nutrition was more likely to be provided across all providers, while weight management and substance abuse was less frequently and less consistently discussed. Relative to doctors in low-risk maternity clinics, midwives were most likely to provide nutrition (OR: 3.09, 95% CI: 1.19–8.01) and weight management (OR: 1.99, 95% CI: 1.13–3.50) advice to women. Conclusion Findings suggest that the type of prenatal advice received by women depends on the provider(s) seen during pregnancy. Substance abuse was least likely to be discussed across providers, suggesting important implications given recent cannabis legalization.
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Affiliation(s)
- Shainur Premji
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
- * E-mail: (SP); (JDZ)
| | - Sheila W. McDonald
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Carol Zaychkowsky
- Population, Public and Indigenous Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer D. Zwicker
- The School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- * E-mail: (SP); (JDZ)
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Alcantara J, Nazarenko AL, Ohm J, Alcantara J. The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique. J Altern Complement Med 2017; 24:90-98. [PMID: 29260894 PMCID: PMC5779240 DOI: 10.1089/acm.2017.0162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women. Design: A prospective cohort within a practice-based research network (PBRN). Setting/Locations: Individual chiropractic offices. Subjects: Pregnant women (age ≥18 years) attending chiropractic care. Intervention(s): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies). Main outcome measures: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL. Results: A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0–42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0–6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = −0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference (p < 0.05). No evidence was found that anxiety (p = 0.1404) or depression (p = 0.8785) changed. Conclusion: A PBRN study was successfully implemented among chiropractors to find pregnant patients highly satisfied and their QoL scores improving with care beyond chance.
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Affiliation(s)
- Joel Alcantara
- 1 The International Chiropractic Pediatric Association , Media, PA.,2 Department of Research, Life Chiropractic College West , Hayward, CA
| | - Andrea Lamont Nazarenko
- 3 Old Mill Chiropractic , LLC, Lexington, SC.,4 Department of Psychology, University of South Carolina , Columbia, SC
| | - Jeanne Ohm
- 1 The International Chiropractic Pediatric Association , Media, PA
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Guliani H. Mix of Maternity Care Providers in Canada. Healthc Policy 2015; 11:46-60. [PMID: 26571468 PMCID: PMC4748365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To identify the factors influencing women's choice of maternity care providers in Canada. METHOD Using the Maternity Experience Survey and a multinomial logit model, this paper examined the influence of various socio-economic and demographic factors on the mix of maternity care providers, while controlling for maternal risk profiles. Additionally, provinces were interacted with maternal age to assess the extent to which regional variations in mix of maternity care providers is influenced by pregnant women's needs. RESULTS Besides maternal risk factors, province of prenatal care and the place of residence were found to be statistically significant determinants of choice of maternity care providers. Analysis involving interaction terms indicated wide regional variations in the mix of providers by maternal age. CONCLUSIONS The results suggest a wide provincial variation in the mix of maternity care providers. New provincial government initiatives are needed to enhance the supply and capacity of care providers.
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Affiliation(s)
- Harminder Guliani
- Assistant Professor, Department of Economics, University of Regina, Regina, SK
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Pinzón-Rondón ÁM, Gutiérrez-Pinzon V, Madriñan-Navia H, Amin J, Aguilera-Otalvaro P, Hoyos-Martínez A. Low birth weight and prenatal care in Colombia: a cross-sectional study. BMC Pregnancy Childbirth 2015; 15:118. [PMID: 25989797 PMCID: PMC4491421 DOI: 10.1186/s12884-015-0541-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/24/2015] [Indexed: 12/13/2022] Open
Abstract
Background Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia. Methods Observational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done. Results A LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR = 0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR = 0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR = 1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW. Conclusion This research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics.
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Affiliation(s)
| | | | | | - Jennifer Amin
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Bogota, Colombia.
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Prelec A, Verdenik I, Poat A. A comparison of frequency of medical interventions and birth outcomes between the midwife led unit and the obstetric unit in low-risk primiparous women. OBZORNIK ZDRAVSTVENE NEGE 2014. [DOI: 10.14528/snr.2014.48.3.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The purpose of this national research was to compare birth, maternal and newborn outcomes in the midwife led unit and the obstetric unit to ascertain whether a midwife led unit reduced medicalisation of childbirth. Methods: A prospective observational case-control study was carried out in Ljubljana Maternity Hospital in the period May - August 2013. The sample comprised 497 labouring women; 154 who attended the midwife led and 343 who attended in the obstetric unit, both matching the same inclusion criteria: low risk primiparous; singleton term pregnancies, normal foetal heart beat, cephalic presentation; spontaneous onset of labour. The primary outcome was the caesarean section rate. Chi-square test was used to compare medical interventions and birth outcomes. Results: Women in the midwife led unit had statistically significant higher spontaneous vaginal births (p < 0.001), less augmentation with oxytocin (p < 0.001), less use of analgesia (p < 0.001), less operative vaginal deliveries (p < 0.001) and less caesarean sections (p < 0.001), lower rates of episiotomy (p < 0.001) and more exclusively breastfed (p = 0.002). Discussion and conclusion: These significant findings showed that in the midwife led unit fewer medical interventions were used. For generalisation of the findings more similar studies in Slovenia are needed.
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ESMAILNASAB N, HASSANZADEH J, REZAEIAN S, BARKHORDARI M. Use of Health Care Services and Associated Factors among Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:70-8. [PMID: 26060682 PMCID: PMC4454030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/11/2013] [Indexed: 11/01/2022]
Abstract
BACKGROUND To estimate the prevalence and analyze factors associated with both public and private health services utilization in women population in a western district of Iran. METHOD A cross-sectional study with 1200 individuals aged 18-49 years carried out in different districts of Sanandaj City, western Iran, in 2012. The main outcome variable was use of health service in the previous 12 months. The in-dependent variables were age, education level, place of residence, marital and pregnancy status, household wealth, oc-cupation and duration time of employment, and rating of quality of health services. RESULTS The prevalence of public and private health services utilization were 60.8% [95%CI: 57.8, 63.8] and 53.8% [95%CI: 50.8%, 56.8%], respectively (P=0.001). After controlling other investigated factors using logistic regression; the academic educational level (OR=1.36, 95%CI: 1.03, 1.80; OR=1.76, 95%CI: 1.33, 2.33), residents of urban (OR=1.65, 95%CI: 1.10, 2.47; OR=1.60, 95%CI: 1.10, 2.42), pregnancy status (OR=2.38, 95%CI: 1.60, 3.55; OR=2.36, 95%CI: 1.61, 3.47), and high level of quality of health services (OR=1.61, 95%CI: 1.15, 2.27; OR=1.70, 95%CI: 1.20, 2.40) were found to be predictors of utilization of both public and private health care respectively. There was also statistically relation between high level of household wealth (OR=3.01, 95% CI: 2.00, 4.57) and private health services utilization. CONCLUSIONS Prevalence of health services utilization varied according to the individual and social factors of popula-tion studied. Present study emphasizes the need to develop care models that focus on the characteristics and demands of the subjects.
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Affiliation(s)
- Nader ESMAILNASAB
- 1. Kurdistan Research Center for Social Determinants of Health (KRCSDH), School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Jafar HASSANZADEH
- 2. Dept. of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab REZAEIAN
- 2. Dept. of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad BARKHORDARI
- 3. Dept. of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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