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Public health policy and practice
Reduced risk of low weight births among indigent women receiving care from nurse-midwives
  1. Paul F Visintainera,
  2. Jane Umana,
  3. Kathy Horganb,
  4. Angela Ibalda,
  5. Uma Vermab,
  6. Nergesh Tejanib
  1. aGraduate School of Health Sciences, New York Medical College, Valhalla, New York, USA, bDivision of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, New York, USA
  1. Dr Visintainer, Graduate School of Health Sciences, Room 213, The Learning Center, New York Medical College, Valhalla, NY 10595, USA

Abstract

STUDY OBJECTIVE To examine the effect of a comprehensive prenatal and delivery programme administered by nurse-midwives on the risk of low weight births among indigent women.

STUDY DESIGN Historical prospective study. Birth outcomes among the cohort were compared with all county births during the same period, adjusting for maternal age and race. Results are expressed as relative risks with 95% confidence intervals.

SETTING An enhanced Medicaid funded pre-natal programme administered by nurse-midwives from 1992 to 1994 in Westchester County, New York.

PARTICIPANTS Indigent mothers (n=1443), between the ages of 15 and 44, who were residents of Westchester County and indicated having Medicaid or no health care coverage.

RESULTS There were 1474 live births among cohort mothers. Mean (SD) gestational age was 39.4 (1.9) weeks. Less than 6% of births occurred before 37 weeks gestation. The mean birth weight of cohort infants was 3365.6 (518.6) g. Only 4.1% of the cohort births were less than 2500 g. Compared with all county births, the cohort showed a 41% reduction in the risk of low weight births (RRlbw=0.59, 95%CI: 0.46 to 0.73, p<.001 ) and a 56% reduction when compared with county Medicaid births only (RR=0.44, 95%CI: 0.34 to 0.57, p<.005) adjusting for maternal age and race. Larger reductions were found for very low weight births.

CONCLUSIONS Mothers need not be considered at high risk for adverse pregnancy outcomes based on their socioeconomic status alone. Moreover, a comprehensive prenatal programme administered by nurse-midwifes may promote a reduction in adverse pregnancy outcomes among indigent mothers.

  • low birth weight
  • prenatal care
  • indigent mothers
  • nurse-midwife

https://doi.org/10.1136/jech.54.3.233

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    Footnotes

    • Funding: this investigation was supported with funds from the New York Medical College Research Endowment in support of the New York Medical College Intramural Research Support Program.

    • Conflicts of interest: none.

    • ↵* Because of restricted access to old medical records and limited resources, we are unable to obtain the participation rate of the 1992–1994 cohort. However, previous reports on the nurse-midwives programme indicate that about 90% of mothers who begin the programme eventually deliver through the programme. To confirm this estimate, we examined a sample of 100 indigent mothers enroled in the nurse-midwife programme during 1998. In this sample, 89% delivered through the programme (including those triaged to Westchester Medical Center), 8% had an early pregnancy loss, and 3% were lost to follow up.