Biomedical subjects

L M Schimmel

Publications and source records attributed to L M Schimmel.

4 recordsLinked to original sources

PubMed1997

Toward lower cesarean birth rates and effective care: five years' outcomes of joint private obstetric practice.

BACKGROUND: Many ways to improve perinatal outcomes, deliver cost-effective care, and increase client and caregiver satisfaction have been suggested. This article adds to the body of such literature by describing a joint practice in California and reporting five years of its outcomes. METHOD: Frequency data were recorded prospectively for all pregnant women seen between January 1, 1991, and December 31, 1995. Overall statistics and variable-specific frequencies were then analyzed for the 1303 consecutive singleton births that occurred during this period. RESULTS: The primary cesarean birth rate for the sample was 6.5 percent, the total rate was 9.1 percent, and the rate for women having their first full-term pregnancy was 11.3 percent. Of all women with a previous cesarean birth, 72.2 percent delivered vaginally. The success rate of attempted vaginal births after cesarean was 83.5 percent. Instrument deliveries were performed for 2.0 percent of births, and the frequency of third- or fourth-degree lacerations was 3.0 percent of all vaginal births. Transfers to a tertiary neonatal intensive care unit were 1.3 percent, and the perinatal mortality rate was 5.4 per 1000 births (corrected for serious anomalies: 3/1000). The preterm birth rate (including maternal transfers) was 2.0 percent. CONCLUSION: An obstetric practice in a private community hospital setting that effectively used obstetricians, nurse-midwives, and nurse practitioners reported low rates of cesarean birth, preterm birth, severe lacerations, instrument deliveries, and legal incidents, and excellent cost-effective maternal and neonatal outcomes.

Adult↗

PubMed1994

A comparison of outcomes between joint and physician-only obstetric practices.

Since 1981, the cesarean birth rate of a joint practice has been consistently lower than that of physician-only practices at a private community hospital in Yolo County, California. This study sought to determine whether differences in perinatal outcomes were influenced by women's use of a joint versus a physician-only practice or were associated with parity, maternal age, or newborn birthweight. Data from the hospital's 1634 consecutive singleton births in 1990 were examined, using a prospective concurrent analytic cohort study design. Chi square statistics and stepwise logistic regressions were used for data analysis. The joint practice had a significantly lower rate of total cesarean births (9.3%) compared with the physician-only practices (17.7%); the frequencies of severe lacerations were 1.0 percent and 6.4 percent, respectively. No significant differences were found in parity, birthweight, or newborn outcomes in the two types of practice. Type of practice was the major determinant of cesarean birth (p < 0.0001). All variables studied, including type of practice, were significant determinants of primary cesarean birth. Parity and practice type were significant determinants of third- and fourth-degree lacerations (p < 0.0001). The type of practice from which women receive care is significantly associated with both method of birth and possibility of severe perineal trauma.

Adult↗

PubMed1991

Cesareans and care.

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Cesarean Section↗

PubMedDate not supplied

The Yolo County Midwifery Service. A descriptive study of 496 singleton birth outcomes, 1990.

The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 +/- 5.5 years, and their mean level of education was 9.9 +/- 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken. Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000. These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.

Adult↗