Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH
{"title":"在助产士陪伴下分娩:费城助产士护理的种族和保险状况与连续性的关系。","authors":"Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH","doi":"10.1111/jmwh.13604","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Introduction</h3>\n \n <p>From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).</p>\n </section>\n \n <section>\n \n <h3> Discussion</h3>\n \n <p>These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.</p>\n </section>\n </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":"69 4","pages":"514-521"},"PeriodicalIF":2.1000,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia\",\"authors\":\"Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH\",\"doi\":\"10.1111/jmwh.13604\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Discussion</h3>\\n \\n <p>These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. 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Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia
Introduction
From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.
Methods
This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.
Results
After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).
Discussion
These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.
期刊介绍:
The Journal of Midwifery & Women''s Health (JMWH) is a bimonthly, peer-reviewed journal dedicated to the publication of original research and review articles that focus on midwifery and women''s health. JMWH provides a forum for interdisciplinary exchange across a broad range of women''s health issues. Manuscripts that address midwifery, women''s health, education, evidence-based practice, public health, policy, and research are welcomed