| Abstrakt: |
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. |
