Intrapartum Transfer Research Articles

Birth Center Outcomes Reported Through Automated Technology

BirthCare HealthCare is a multidisciplinary health care clinic and freestanding birth center in Salt Lake City, Utah. Highlights of a woman's labor assessment and birth outcomes are summarized in a paper birth log. The authors developed a relational database that facilitates efficient outcomes reporting. Examples of outcomes from this database are reported. This study describes clinical outcomes from a freestanding birth center and the automated birth log database used to manage outcomes reporting. Retrospective data obtained primarily from a paper birth log and secondarily from the paper chart were entered into and extracted from an electronic database. 231 women who were evaluated in 269 encounters for delivery at the birth center between July 1, 1997, and June 30, 1999. MAIN CLINICAL OUTCOME MEASURES: The number of deliveries at the birth center; the percentage of intrapartum, postpartum, and newborn transfers to the inpatient hospital setting; cause-specific transfer rates; method of transfer; medication in labor; low and high birth weights; percentage of low Apgar scores; and average times from admission to birth and birth to discharge. Birth center clinical outcomes can be efficiently reported using an automated birth log. Clinical outcomes reported in this study are consistent with finding of previous research that demonstrates that birth centers are a safe alternative site for delivery.

Vaginal birth after cesarean in a hospital-based birth center staffed by certified nurse-midwives

The efficacy and safety of a trial of labor after previous cesarean were evaluated in selected, low-risk women in a hospital-based birthing center staffed by certified nurse-midwives. A total of 303 low-risk women with one previous cesarean delivery underwent a trial of labor in the birthing center. A matched control, without a previous uterine incision, was selected for each study patient. Hospital charts of 298 matched pairs were available for analysis. Outcome measures included the requirement for intrapartum transfer to medical management, use of oxytocin, method of delivery, uterine scar separation, Apgar scores, birth weights, maternal febrile morbidity, and length of hospital stay. Intrapartum transfer to medical management was necessary in 26 (8.7%) study patients and 31 (10.4%) control subjects. The overall rate (98.3%) of vaginal birth after cesarean among study patients was not statistically different from the vaginal birth rate (99.3%) among control subjects. There were no differences in maternal or neonatal morbidity. The high percentage (84%) of study patients having had a previous uncomplicated vaginal birth after cesarean must be considered a potential limitation of the outcome data; however, the overall vaginal birth rate between study patients with and study patients without previous vaginal birth after cesarean was not statistically different. The latter group was more likely to require transfer to medical management and/or oxytocin augmentation. On the basis of these results, we concluded that for selected, low-risk patients, a trial of labor after one previous cesarean may be managed safely and effectively by certified nurse-midwives in a hospital setting.

Transfer rates from freestanding birth centers A comparison with the National Birth Center Study

This article reviews retrospective data derived from Sharp The BirthPlace, San Diego for 1993–1994 and from the University of California, Irvine, Birthing Center for 1994 and compares these findings to data obtained from the National Birth Center Study (NBCS). The focus of this article is on intrapartum transfer rates from the two freestanding birth centers as a critical clinical indicator. Cause-specific transfer rates were calculated for eight clinical conditions. Data suggest that cause-specific intrapartum transfer rates are influenced by factors such as risk profile of the client population, distance to the referral center and mechanisms of transfer, definitions and diagnostic criteria used, and clinical practice guidelines. Reports from the literature, such as NBCS data, might serve as points of reference, but are likely not appropriate baseline indicators (benchmarks of “best practice”) for clinical events, against which individual performance can be measured; rather, these benchmarks should be individually defined, based on characteristics unique to each birth center.

Prospective regional study of planned home births. Home Birth Study Steering Group.

To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners. Follow up study with anonymised postal questionnaires. Northern Regional Health Authority area. The 256 women resident in the Northern region who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on all other women delivering a baby outside hospital in 1993. Rate of and reason for transferred care; maternal, midwifery, and general practitioner views; perinatal outcome. Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of the midwife and general practitioner.

Study shows interventionist nature of British obstetrics

EDITOR,—The high rate of antepartum and intrapartum transfer of women from the midwives unit to the labour ward (1030 out of 1900) requires further explanation than V A Hundley and colleagues give in their discussion of the trials of the midwives unit in Aberdeen.1 Table V shows that there were only 374 medical interventions during delivery if one assumes that all the caesarean sections and forceps and …

Twelve years and more than 30,000 nurse-midwife-attended births: The Los Angeles County + University of Southern California Women's Hospital birth center experience

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.

Contribution of general practitioners to hospital intrapartum care in maternity units in England and Wales in 1988.

To ascertain the contribution of general practitioners to hospital intrapartum care in 1988. Confidential postal questionnaire. All maternity units in England and Wales. Type of general practitioner unit (if any); number of bookings, transfers, and deliveries by general practitioners; participation of general practitioners in the policy and audit of the unit. 277 (93%) of 297 units replied. Of 611,644 deliveries, 36,043 (5.9%) were under general practitioner care. In all, 228 units permitted general practitioners to book women under their sole care: 65 were isolated, 29 alongside, and 134 integrated general practitioner units. Alongside units had significantly more bookings (568), antenatal transfers (69), intrapartum transfers (86), and deliveries (387) compared with isolated units (185, 18, 16, and 125, respectively) and integrated units (106, 18, 18, and 52) (p less than 0.001 for all differences). The percentage of women booked by general practitioners transferred either before or during labour was independent of both the type of unit and the number of general practitioner bookings. General practitioners in consultant units were significantly less likely to attend meetings reviewing perinatal mortality (p less than 0.01), and these units were less likely to have any form of general practitioner-consultant liaison committee (p less than 0.001) compared with general practitioner units as a whole. Compared with those in isolated and alongside units, general practitioners in integrated units were less likely to have taken part in deciding the unit's booking policy (p less than 0.01) and consultants more likely to be the final determinant of whether a general practitioner should be permitted to practice within the unit (p less than 0.001). Both the number of deliveries booked by general practitioners and the number of isolated general practitioner units have fallen. Transfer from general practitioner to consultant care was independent of the general practitioner unit's caseload or the type of unit. General practitioner units differ from consultant units in important ways and differ among themselves as well. Except in remote areas, alongside units may be the ideal type of unit to encourage general practitioners to continue to provide intrapartum care.

Detection and management of gestational diabetes in an out-of-hospital birth center

The incidence of Gestational Diabetes Mellitus (GDM) reported in an out-of-hospital birth center serving 95% Hispanic women was 10%. A program to comanage the care of GDM clients by certified nurse-midwives (CNM) and their physician consultants is described. The antepartum, intrapartum, and neonatal characteristics of 119 GDM clients between 1983 and 1985 is discussed. Intrapartum and newborn transfers to the hospital were similar when the GDM group was compared to the total population serviced by the birth center during 1984. There were no neonatal deaths in the GDM group. Macrosomia did oocur in 26% of the babies of GDM mothers and shoulder dystocia was reported in 7.6%. The results suggest that a quality program can be established to care for GDM mothers in an out-of-hospital birth center. However, ways other than just good glucose control may be necessary to further decrease the incidence of fetal macrosomia.

Kernicterus in erythroblastosis fetalis

Summary In a series of seventy-two cases of erythroblastosis fetalis there were twenty-fivedeaths with twenty-one autopsies. Four of the surviving patients have mental retardation. An unfavorable outcome was associated with the clinical or pathologic signs of kernicterus in twenty cases. In twelve cases of kernicterus there were also focal pulmonary hemorrhages and these infants displayed a striking clinical picture, made up variously of drowsiness, spasticity, opisthotonos, signs of motor irritability, respiratory irregularity, pulmonary râles and rhonchi, and bloody discharge from the upper respiratory tract. Clinical and pathologic features of the cases with kernicterus suggest thatblood destruction is not the primary determinant of nuclear damage. The possible roles of immaturity, vascular injury, altered antigen-antibody reactivity, and intrapartum transfer of antibody in the pathogenesis of kernicterus are discussed.