SIXTY YEARS OF NURSE MIDWIFERY: PRACTICE-OUTCOME ANALYSI

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The specific aims of this study are to: (a) describe the population of women receiving maternity care provided by the nurse- midwives of the Frontier Nursing Service (FNS) in the 60 years since establishment of the service; (b) compare pregnancy outcomes in terms of nationally accepted parameters used to evaluate quality of maternity care as reflected by maternal morbidity - mortality rates and perinatal morbidity and mortality rates; and (c) depict and describe nurse midwifery practices and their evolution at the FNS since 1925. Research questions include: (1) What is the comparison of FNS maternal infant outcomes to relative county, state, and national maternal infant outcomes in ten year increments of time from 1925 to 1985? (2) What is the relationship between FNS nurse- midwifery practices and maternal infant outcomes.? Information related to 22,000 births managed by nurse-midwives at the FNS will b extracted from the microfiched medical records of women delivered in the years 1925 to the present. The probability sample will consist of a stratified random sample of records. Strata will be years and then time periods corresponding to changes in medical record design. Quantity and quality of data, as well as the optimal procedure for data entry will then be assessed for each time period. Interrater reliabilities on research assistants will also be calculated. Research assistants will enter data directly from the microfiched records to the computer. A paperless data entry tool, by which the use of formatted "screens appear on the monitor, enables data to be recorded directly on the computer in an efficient and accurate manner. Quality control measures and cleansing of the data set will occur. Descriptive statistics will document nurse-midwifery practices. Statistical analysis will be performed using the S statistical package developed by AT & T Bell Laboratories. Aggregations for comparisons for site and situation of delivery will be defined in terms of ten year intervals and will compare FNS outcomes to baseline regional, state, and national figures for the same approximate time period. The chronological relationship of key outcomes in the population served by the FNS to appropriate socioeconomic and environmental factors since 1925 will be shown in a graphical format.