Practitioners as educators. One solution to the CNM shortage.
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Biomedical subjects
Publications and source records attributed to L S Clay.
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External cephalic version has been used periodically for centuries to manage breech presentations. As cesarean section rates have escalated in the last two decades, ways to curb this rise have been evaluated. By reducing the number of infants that arrive in labor in a malpresentation, it is possible to impact the overall cesarean section rate. External cephalic version is a safe, effective method when used in appropriate cases of breech presentation. A forward or backward roll can be accomplished in women at term with singleton gestations, adequate amniotic fluid, and reactive nonstress tests. Parity, fetal and placental position, and descent of the presenting part may all influence the success rate of the version.
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As more women have their well woman gynecologic needs met by CNMs, the impact of the midwife's role as a coordinator of women's health care becomes clearly evident. Midwives must become experts in screening women of all ages for a variety of health care concerns and they must be versed in many aspects of gynecologic care, beginning with the Pap smear. As the incidence of human papilloma virus has increased significantly in recent years, so has the incidence of cervical dysplasia. Understanding the epidemiologic factors for cervical dysplasia and the courses of therapy used are integral parts of comprehensive nurse-midwifery care.
Prior to the 1960s, little was known about morbidity and mortality in humans due to group B streptococcus (GBS). Since that time, a thorough understanding of the organism's potential has been developed. Of pregnant women, 20-30% are prenatal carriers of GBS and 40-75% of these mothers will transmit GBS to their neonates. However, the actual incidence of GBS disease in infants is one to three cases per 1,000 live births. Several risk factors for transmission and development of early-onset GBS disease have been identified. The understanding of late-onset disease is less clear. Many strategies have been investigated to find an optimal protocol to reduce significantly the incidence of GBS disease in a cost-effective manner. The Centers for Disease Control and Prevention have recently made recommendations for prevention strategies against this disease.