PubMed · 8233950
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T Reid. Birth pangs.. https://pubmed.ncbi.nlm.nih.gov/8233950/
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Despite efforts to improve prenatal and perinatal health care in developing countries, child-birth remains hazardous for both mother and child. Several measures have been initiated to try to improve maternal and perinatal morbidity and mortality. One such measure is the establishment of maternity waiting shelters at hospitals where mothers can wait so that, when they go into labour or develop antenatal complications, they can transfer to the hospital wards for management and safe delivery. From May 1987 to April 1989, we evaluated pregnancy outcome among 280 women using such a shelter in a remote rural district in Zimbabwe. Perinatal mortality was higher (29.8 per 1000) among 773 non-waiting mothers than among the waiting mothers (25.0 per 1000), although this was not statistically significant (p > 0.05). However, there were significantly more low birthweight babies (11.4%) among the non-waiting mothers than among the waiting mothers (4.3%) (p < 0.01). Fetal deaths were more common than early neonatal deaths, suggesting that maternal factors accounted for most of the perinatal deaths. Poor pregnancy outcome was associated more with primigravidae and grand multigravidae than with those who had had one to four pregnancies. We conclude that maternity waiting shelters can contribute to preventing low birthweight and, to a lesser extent, improve perinatal outcome. There is a need to strengthen health care referral systems and to increase efforts to improve other determinants of perinatal and maternal morbidity and mortality.
The roles for certified nurse-midwives are growing, changing, and becoming more varied with the reform of health care systems. Versatility of clinical knowledge in antepartum, intrapartum, postpartum, and gynecologic care along with advanced practice skills of assessment, diagnosis, and treatment make nurse-midwives ideal providers to perform triage for a busy obstetric service. With health care dollars more limited and more scrutinized than ever before, it becomes essential to prioritize patient needs and match them with the most appropriate resources. The article demonstrates the process of triage provided by certified nurse-midwives in a high-volume university hospital setting. It describes management guidelines and admission criteria for the birth center, high-risk labor and delivery, and the observation unit. Examples of clinical evaluations and judgments as well as scenarios are included to illustrate how triage is unique and differs from care provided in other settings.
Midwifery and birth centers are placed within a concept of social structuring of difference between dominant and subordinate groups and their resultant inequality. Midwifery, and the birth center as a place for the practice of midwifery, present a philosophical view of childbirth that is different from the existing medical and acute care view and rooted in the education and socialization of the respective practitioners. In exercising freedom to act on that philosophical view, nurse-midwives and the physicians and nurses with whom they practice in birth centers are well positioned to be included in the reform efforts to devise a system for improving access to affordable quality health care.