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Epidural placement, transfers, and a...

Nguyen, Uyen-Sa Duc Tran.

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Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study./
Author:	Nguyen, Uyen-Sa Duc Tran.
Description:	97 p.
Notes:	Adviser: Kenneth J. Rothman.
Contained By:	Dissertation Abstracts International68-08B.
Subject:	Health Sciences, Obstetrics and Gynecology. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3279949
ISBN:	9780549210856

Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study.
Nguyen, Uyen-Sa Duc Tran.

Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study. - 97 p.

Adviser: Kenneth J. Rothman.

Thesis (Sc.D.)--Boston University, 2007.

Studies have shown that nurse-midwifery patients at birth centers have lower resource utilization and medical interventions as compared with patients of traditional care with hospital delivery.1, 2 The SDBCS was a prospective cohort study that compared the collaborative Certified Nurse Midwife-Doctor Management and planned birth center delivery with the traditional Doctor Management and hospital delivery, in a population of low-income women.

ISBN: 9780549210856Subjects--Topical Terms:

1020690
Health Sciences, Obstetrics and Gynecology.

Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study.
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020 $a 9780549210856
035 $a (UMI)AAI3279949
035 $a AAI3279949
040 $a UMI $c UMI
100 1 $a Nguyen, Uyen-Sa Duc Tran. $3 1265920
245 1 0 $a Epidural placement, transfers, and adequacy of prenatal care utilization in the San Diego Birth Center Study.
300 $a 97 p.
500 $a Adviser: Kenneth J. Rothman.
500 $a Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5150.
502 $a Thesis (Sc.D.)--Boston University, 2007.
520 $a Studies have shown that nurse-midwifery patients at birth centers have lower resource utilization and medical interventions as compared with patients of traditional care with hospital delivery.1, 2 The SDBCS was a prospective cohort study that compared the collaborative Certified Nurse Midwife-Doctor Management and planned birth center delivery with the traditional Doctor Management and hospital delivery, in a population of low-income women.
520 $a The SDBCS provided the base population for the current research. The aims of the current research are to: (1) explore epidural analgesia on risk for cesarean sections and operative births; (2) examine predictors of transfer and elucidates possible reasons for non-medical transfer; and (3) investigate the Kotelchuck Adequacy of Prenatal Care Utilization (APNCU) Index as a measure of utilization and determine if the classification of adequacy of utilization would change with slight changes in the definition.
520 $a Results indicate that epidural analgesia was associated with a 10.4% increase in absolute risk for cesarean delivery in nulliparous and a 1.2% increase in multiparous women. For assisted delivery, there was a 19.3% increase in absolute risk in nulliparous and a 13.7% increase in multiparous women. The second study finds that nulliparous women were at 1.5 times the risk of being transferred as compared with multiparous women who had never had a cesarean and whose previous children were never delivered at a hospital. Multiparous women with previous cesarean sections, and women without previous cesarean sections but with a previous child delivered at a hospital, were at 1.7 and 1.6 times the risk of being transferred, respectively. In the third study, using a different definition of gestation month resulted in 6.7% of the Intermediate, 6.0% of the Adequate, and 4.3% of Adequate Plus in the original APNCU Index to be re-classified as Inadequate. Also, including gestation month 5 in the classification of adequate care, instead of <5, resulted in people classified as Inadequate to be re-classified as Intermediate (4.6%), Adequate (15.5%), and Adequate Plus (26.0%).
520 $a The contributions of this research includes the examination of the effect of epidural analgesia on risks for cesarean sections and assisted deliveries in a group of multiparous women while rigorously controlling for confounding factors. Further, information about transfer risks can help practitioners and policy makers determine populations appropriate for birth center deliveries. This research also suggests that the classification of month prenatal care began and the proportion classified as having adequate prenatal care utilization can vary with slight changes in the definition of APNCU and may impact health care policy.
590 $a School code: 0017.
650 4 $a Health Sciences, Obstetrics and Gynecology. $3 1020690
650 4 $a Health Sciences, Public Health. $3 1017659
690 $a 0380
690 $a 0573
710 2 $a Boston University. $3 1017454
773 0 $t Dissertation Abstracts International $g 68-08B.
790 $a 0017
790 1 0 $a Rothman, Kenneth J., $e advisor
791 $a Sc.D.
792 $a 2007
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3279949