EVALUATION OF A PUBLIC-PRIVATE CERTIFIED NURSE-MIDWIFE MATERNITY PROGRAM FOR INDIGENT WOMEN.
Contributors: University of Washington.
Published: 1995
Number of pages: 77
Subjects: Health Sciences, Public Health.; Health Sciences, Obstetrics and Gynecology.
Description: A clear need exists to provide adequate prenatal and delivery services, especially among the medically indigent. The Boulder County Health Department initiated a CNM program in response to deteriorating access to maternity services for low income women. A population-based quasi-experimental study was undertaken comparing the intervention county with two non-intervention (control) counties. The study included all low income women who gave birth to a singleton infant between September 1989 and December 1990. Birth certificate data, matched to Medicaid and Colorado Indigent Care Program lists, provided the primary source of data.

There were 692 livebirths in the intervention county, and 726 and 1373 for each of the two control counties available for study. There were negligible differences between the intervention and comparison counties in the onset of late or no prenatal care (54.5% vs 51.4%, respectively). However, the proportion of women who received no prenatal care was significantly lower in the intervention county compared to the control counties (0.7% vs 2.4%; OR = 0.31, 95% CI 0.12,0.78). Less-than-adequate prenatal care (as assessed by the Kessner index) was significantly reduced among intervention women compared to controls (47.5% vs 55.4%; OR = 0.73, 95% CI 0.61,0.87). Assessment of the incidence of antepartum complications found anemia was significantly reduced among women from the intervention county (0.7% vs 2.2%; OR = 0.33, 95% CI 0.10,0.84), gestational diabetes was slightly elevated (1.3% vs 1.1%; OR = 1.14, 95% CI 0.43,3.03), and pregnancy induced hypertension was significantly higher (3.7% vs 2.1%: OR = 1.75, 95% CI 1.06,2.88) relative to controls.

The use of induction and/or stimulation of labor were both found to be significantly higher among intervention women relative to non-intervention women (induction 18.2% vs 9.9%; stimulation 14.9% vs 10.4%). The proportion of deliveries by cesarean were nearly identical between the two populations (intervention = 13.0% vs controls = 13.3%), however intervention women were more likely to have had a successful vaginal birth after cesarean compared to controls (47.6% vs 34.7%; OR = 1.71, 95% CI 0.79,3.70). The occurrence of prematurity was reduced among the intervention cohort (5.9% vs 8.0%; OR = 0.72, 95% CI 0.51,1.03), as was the proportion of low birth weight infants among the intervention county (7.1% vs 9.4%; OR = 0.73, 95% CI 0.52,1.03), although these differences were not quite significant.

These results suggest the public-private CNM maternity program was associated with markedly improved prenatal, delivery and birth outcomes among indigent women.
Notes: Source: Dissertation Abstracts International, Volume: 56-07, Section: B, page: 3716.

Thesis (PH.D.)--UNIVERSITY OF WASHINGTON, 1995.

School code: 0250.