Premium
Maternity Care and Outcomes in a High‐Risk Service: The North Central Bronx Hospital Experience
Author(s) -
Haire Doris B.,
Cram Elsberry Charlotte
Publication year - 1991
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/j.1523-536x.1991.tb00051.x
Subject(s) - medicine , disadvantaged , psychological intervention , population , prenatal care , pregnancy , family medicine , obstetrics , nursing , environmental health , political science , law , genetics , biology
The maternity service of the North Central Bronx Hospital, a New York City municipal hospital for the medically indigent, has demonstrated that good maternal and infant outcomes can be obtained in an unselected population of disadvantaged women by using obstetric interventions only when medically indicated. Approximately 70 percent of the mothers cared for in the service are considered at risk or high risk. Of the 3287 deliveries in 1988, 86.1 percent were performed by the midwives on staff. Midwives were the primary providers of prenatal, intrapartum, and postpartum care for all low‐risk mothers, and comanaged with the attending obstetricians the care of all high‐risk mothers. The cesarean section rate was 11.8 percent, and the rate of instrumental delivery was 0.3 percent, with minimal use of oxytocin augmentation (6.4%). Among the 3323 infants delivered in 1988, the last full year before an obstetric residency program was established, the rate of those requiring special or intensive care was 11.1 percent, and neonatal mortality was 9.2 per 1000 live births for all birth weights and 3.7 per 1000 for infants over 1000 g. The experience gained from 10 years and over 25,000 births suggests that the maternity care of both high‐ and low‐risk mothers could be improved by minimizing obstetric intervention whenever possible.