Twelve years and more than 30,000 nurse-midwife-attended births: the Los Angeles County + University of Southern California women's hospital birth center experience.
This article describes the setting, policies, practices, and outcomes of the nurse-managed in-hospital birth center at Los Angeles County + University of Southern California Women's Hospital, where women are selected upon admission for birth center care. A retrospective review of available data was made; when compared with hospital records, the primary data source was found to be 96% accurate. Results of the review indicated that from 1981 to 1992, there were 36,410 birth center admissions and 30,311 births, all attended by nurse-midwives; no intrapartum maternal or fetal deaths occurred among all admissions. The intrapartum transfer rate averaged 17%, and declined steadily from a high of 28% in 1982 to a low of 7% in 1990. More in-depth review showed an overall primary cesarean birthrate of 1.8% and an operative birthrate of 4% among the 25,890 admissions and 22,490 births from 1985 to 1992. Detailed postpartum and newborn outcomes from 1982 to 1986 showed a neonatal intensive care unit admission rate of 1.5% and a one-week newborn readmission rate of 1.3% among newborns discharged within 12 to 24 hours; 85% of all newborns returned for follow-up care. This large longitudinal experience demonstrates excellent outcomes that can be achieved when nurse-midwives, working cooperatively with a multidisciplinary health care team, provide in-hospital birth center care to a predominately low-income Hispanic population using a variety of less-traditional intrapartum management techniques. Broader implications for making alternative maternity care services available for low-income women with nurse-midwives and nurses playing a central role are discussed.
Greulich
B
B
Nurse-Midwifery Service, Women's Hospital, Los Angeles, CA 90033.
Paine
L L
LL
McClain
C
C
Barger
M K
MK
Edwards
N
N
Paul
R
R
D000293:Adolescent; D000328:Adult; D003696:Delivery Rooms / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006766:Hospitals, County; D006785:Hospitals, University; D006801:Humans; D008137:Longitudinal Studies; D015141:Los Angeles; D009721:Nurse Midwives / Q000458:organization & administration*; D009731:Nursing Audit; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies