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Medical Liability Insurance Data Analytics
Published in Salvatore Volpe, Health Informatics, 2022
The goal being identification of those circumstances that present opportunity to change practice to enhance patient outcome, it is apparent that malpractice claim data can be sliced and diced in countless ways. Should we look at instances of birth injuries occurring at acute care facilities in upstate New York to mothers over 35 years old with gestational diabetes and lacking prenatal care? Can we study adverse outcomes involving nurse midwives? Do we add cesarean section (C-section) versus normal vaginal delivery as a factor? Was the C-section emergent? Was it an attempted VBAC (vaginal birth after C-section)? What were the indications of fetal distress, Apgar score, chord gases, and so forth? The point is that data can lead us in different directions, much worth pursuing toward our goal. We have taken the time and spent resources to conduct analysis of a class of cases; that analysis may lead to some conclusions that identify a new or more specific class of cases, and that class may be worthy of analysis. Review of insurance carrier’s case files and medical records each time another worthy query presents itself is beyond impractical for these deeper dives and cannot yield a satisfying risk management direction.
Struggle between providers and recipients: the case of birth practices
Published in Ellen Lewin, Virginia Olesen, Women, Health, and Healing, 2022
The option of an out-of-hospital maternity center to provide a compromise between home and hospital may be a way to integrate the trend towards self-help and demedicalization of birth with a more active political approach to change. There are about a hundred freestanding centers in the United States, most of which are run by nurse-midwives; and at the time of this writing, none in Canada. The best-known freestanding birth center is the Childbearing Center of the Maternity Center Association, New York City. In operation since 1975, its goal is to be an extension of the home, rather than a mini-hospital. The birth team consists of nurse-midwives, pediatricians, publichealth nurses, and support persons who do a careful screening of applicants, providing comprehensive prenatal care. The center has emergency back-up equipment, is within a short drive to the nearest back-up hospital, is less costly than the hospital, and has an excellent safety record. The Childbearing Center, however, had major difficulties becoming established, meeting resistance from the medical establishment, the New York City Health Department, and funding agencies. Having overcome its initial problems and in operation for over nine years now, it is continually scrutinized by the Department of Health, and by obstetricians and gynecologists who see its existence as threatening (Lubic 1981).
Underdogs, turf wars and revivals
Published in Hanna Laako, Georgina Sánchez-Ramírez, Midwives in Mexico, 2021
In this way, a relatively autonomous, modern midwifery was established in some Western countries. In postwar Europe, midwives became particularly autonomous professionally in the Nordic countries, the Netherlands (where they had long been so) and to some extent in Britain. In many other Western countries, where midwifery did not manage to safeguard its professional autonomy, many midwives took up nursing careers or practiced in hospitals as nurse-midwives subordinated to obstetricians.
Enhancing interprofessional collaboration and interprofessional education in women’s health
Published in Medical Education Online, 2022
Laura Baecher-Lind, Angela C. Fleming, Rashmi Bhargava, Susan M. Cox, Elise N. Everett, David A. Forstein, Shireen Madani Sims, Helen K. Morgan, Christopher M. Morosky, Celeste S. Royce, Tammy S. Sonn, Jill M. Sutton, Scott C. Graziano
Obstetrics and Gynecology has long been a collaborative specialty. Even well into the 20th century, women sought care from traditional birth attendants for expertise in pregnancy and childbirth rather than from a physician. In the 1940s, nurse midwifery was promoted by public health nurses, social reformers, and obstetricians in order to reduce maternal morbidity and mortality [10]. Expertise in pregnancy and childbirth is now shared between obstetricians and other health-care providers including nurse midwives, family medicine physicians, women’s health nurse practitioners, physician assistants, and doulas. Nearly 13% of women in the USA choose a midwife rather than an obstetrician for their care [11]. Women receiving care with midwives experience fewer interventions in labor and have reduced risks of cesarean section or operative vaginal delivery [12]. It is recognized that increasing access to and learning best practices from nurse midwifery may be a primary strategy to continuing to reduce maternal morbidity and mortality in the USA [11–13]. Team-training, a form of interprofessional education, has been shown to reduce rates of adverse obstetric events including return to the operating room and birth injury [14].
Screening test characteristics and comparison of diabetes outcomes among pregnant patients with prediabetes
Published in Journal of Obstetrics and Gynaecology, 2022
Gianna L. Wilkie, Ellen Delpapa, Heidi K. Leftwich
Our findings also showed that women with prediabetes were at an increased risk of developing GDM, with approximately 61.3% of patients receiving a diagnosis of GDM in the third trimester. This is higher than the rates reported in other literature, which ranged from 29.1% to 47.7% (Osmundson 2016, Chen 2019). The higher percentage of patients may be explained again by the risk factor based screening approach rather than universal screening as this may identify a more at risk population of developing GDM at baseline. Given our hospital is in an urban setting with a higher population of high-risk individuals, our population may be at higher risk for prediabetes and diabetes. Monitoring and treatment practices likely varied among patients with a known diagnosis of prediabetes, and actions taken by providers may have had an impact on diagnosis of GDM. Additionally, our population reflects low and high-risk obstetrics clinics, as well as prenatal patients who seek prenatal care from family medicine physicians, nurse midwives and nurse practitioners. We acknowledge that provider driven risk-based screening may be slightly different in each of these settings. Nonetheless, this cohort of pregnant patients with an early diagnosis of prediabetes is at risk for developing gestational diabetes, which is known to be associated with numerous maternal and fetal adverse outcomes (Ovesen et al.2015, Bengtson 2021).
Confidential review of maternal deaths in a South Indian state: current status and the way forward
Published in Sexual and Reproductive Health Matters, 2022
Muthusamy Santhosh Kumar, R. Sharon Annie Metilda
The media reports also underscore the non-availability of doctors at the time of delivery. However, the first point of contact in the public health care system is PHCs, where doctors are not available round the clock. In India, and likely many low- and middle-income countries, a doctor-centred approach is not feasible. In such settings, well-trained nurse-midwives can conduct deliveries and refer women with complications to higher centres.20 The MDSR process could also review how well deliveries and emergency referrals by trained midwives are handled, to improve future performance. Media reporting of maternal death as seen in these case scenarios was often patchy and incoherent, eliciting a defensive response from healthcare professionals and administrators. Poor quality reporting by a leading local language magazine highlights the need for systematic investigation of maternal deaths, together with clear and transparent communication with the media to clarify findings and to avoid apportioning arbitrary blame on clinical staff. In such scenarios, confidential review of maternal deaths will be helpful in identifying the actual cause of death.