Providing culturally competent primary care for immigrant and refugee women. A Cambodian case study.

Currently, one of every 13 U.S. residents is foreign born. A 1991 survey of certified nurse-midwives (CNMs) indicated that 51% of the respondents serve immigrant women. Using a case study approach, this article illustrates barriers to health care experienced by foreign-born women and demonstrates how cultural competence increases provider effectiveness in meeting the unique needs of this population. Effective primary care requires understanding the context of the refugee experience and its physical and emotional sequelae; addressing geographic, linguistic, economic, and cultural barriers; and providing high-quality care through the efficient use of resources without unduly controlling women's choices. Providing care within the context of the traditional family structure, gender roles, family support systems, and community services and resources further enhances health care services. Equally important is the establishment of a sustained partnership with clients, based on the support of protective traditional health practices and the recognition that a woman is expert in her own health. By respecting the complex cultural, political, economic, and personal backgrounds that contribute to immigrant women's perceptions of health, illness, and health care needs, culturally competent primary care providers serve diverse populations more effectively and help to enrich the communities in which they live and work.

Primary care for women. Management of common musculoskeletal disorders.

This article provides a review of common adult musculoskeletal disorders including diagnosis and treatment guidelines to assist certified nurse-midwives in their role as primary care providers. Disorders requiring referral as well as signs and symptoms indicating potentially serious underlying problems are emphasized.

Primary care for women. Comprehensive assessment of the respiratory system.

This article reviews the anatomy and physiology of the respiratory system and provides techniques for the physical assessment and data collection for common respiratory complaints in women. The pertinent historical, physical examination, and laboratory data for asthma, pneumonia, bronchitis, cough, and tuberculosis are also presented. This article is the first of two articles on primary care for women with respiratory complaints; the subsequent article will address primary care management of common respiratory conditions.

Primary care for women. An overview of the role of the nurse-midwife.

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.

Outcomes of mature primiparas in an out-of-hospital birth center.

This is a retrospective chart review of perinatal outcomes of all primiparas over the age of 24 delivering at Maternity Center Associates, an out-of-hospital birth center, from January 1985 through May 1988 (N = 228). Chi-square analysis was used to determine whether mature primiparas, aged 35 to 43 (n = 27), had significantly more adverse outcomes than younger primiparas, aged 25 to 34 (n = 201). There was a significant difference between the groups in rate of transfer to hospital; however, there were no significant differences in rate of cesarean section, infant birth weight, apgar scores, and length of second stage labor. Implications for practice and future study are examined.

Effects of lateral recumbency and sitting on the first stage of labor.

We compared uterine activity in lateral recumbency and the sitting position during the first stage of labor in a group of nulliparas. Lateral recumbency was accompanied by more intense, less frequent and more efficient uterine contractions than sitting. Patients preferred sitting for the first half of labor and lateral recumbency for the second. No adverse fetal reaction was noticed in either position, judging from the fetal heart rate. An increase in maternal pulse rate during sitting could have indirectly indicated some compression of the prevertebral vessels. Maternal position clearly affects several parameters of labor, and its selection should be based upon maternal comfort, uterine contractility and efficiency, and hemodynamic repercussions.