부산대학교 도서관

INTRODUCTION:: To examine the effects of a Collaborative Laborist and Certified Nurse Midwife (CNM) Model on the rates of induction, primary and repeat cesarean sections, vaginal birth after cesarean (VBAC), and nursing staff satisfaction with this model of care. METHODS:: This was a prospective cohort study at the largest birthing center in South Dakota between 2008-2016. Rates of induction, primary and repeat cesarean section, VBAC, and nursing staff satisfaction were compared over three 2 year time periods: before and after Laborist Model initiated and with the addition of CNM to the model. Linear regression and two-way ANOVA were used to compare trends of primary cesarean, repeat cesarean, VBAC, and induction. A two-tailed t-test compared values of nursing satisfaction. RESULTS:: The primary cesarean delivery and induction rate decreased from 15.9% to 13.5% (P < .005 95% CI 0.67–0.22) and 49.38% to 30.75% (P < .006 95% CI 7.24–1.23) respectively. VBAC success rates increased from 1.55% to 2.21% (P < .017 95% CI .07-.23) of all deliveries. There was a significant increase in respect between physician and staff (P < .01 8.9% difference), NICU communication (p < .001 16.2% difference), and provider involvement in triage (P < .001 27.9%) This difference was shown following addition of CNMʼs. CONCLUSION:: The rates of primary cesarean section and induction are significantly decreasing at the same time as the rate of VBAC is increasing. These results represent an overall positive outcome of employing the Laborist and CNM Collaboration Model.