{"id":25956,"date":"2024-06-26T04:12:00","date_gmt":"2024-06-25T20:12:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25956"},"modified":"2024-06-26T05:32:14","modified_gmt":"2024-06-25T21:32:14","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8a%a9%e4%ba%a7%e5%a3%ab%e6%88%96%e4%ba%a7%e7%a7%91%e5%8c%bb%e7%94%9f%e6%8e%a5%e7%94%9f%e5%90%8e%e4%ba%a7%e5%a6%87%e6%80%a5%e8%af%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25956","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u52a9\u4ea7\u58eb\u6216\u4ea7\u79d1\u533b\u751f\u63a5\u751f\u540e\u4ea7\u5987\u6025\u8bca\u79d1\u5c31\u8bca\u60c5\u51b5"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Obstetrics and Gynecology<\/p>\n\n\n\n

April 29, 2024<\/p>\n\n\n\n

Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care<\/h1>\n\n\n\n

Carla Sorbara, Joel G. Ray, MD, Elizabeth K. Darling, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2024;7(4):e248676. doi:10.1001\/jamanetworkopen.2024.8676<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is care by a midwife compared with an obstetrician associated with different rates of emergency department (ED) use in the postpartum period?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 104 995 patients who were low risk, women receiving innovative midwifery-model care experienced a 22% lower risk of ED use post partum than patients receiving traditional obstetrics-model care.<\/p>\n\n\n\n

Meaning<\/strong>  These findings suggest that midwifery-model care, which offers early postpartum visits, may reduce maternal ED use after birth; this approach may fill an important gap in postpartum care.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.<\/p>\n\n\n\n

Objective<\/strong>  To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.<\/p>\n\n\n\n

Exposures<\/strong>  Perinatal care clinician, namely, a midwife or obstetrician.<\/p>\n\n\n\n

Main Outcome and Measures<\/strong>  :<\/strong> Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23\u202f124 women (6.7%) with midwifery-model care compared with 6902 of 81\u202f871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Obstetrics and Gynecology […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25956"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25956"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25956\/revisions"}],"predecessor-version":[{"id":26212,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25956\/revisions\/26212"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25956"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25956"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25956"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}