Midwifery care during labor and birth in the United States.

The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.

Need for paediatric surgery care in an urban area of The Gambia.

The report evaluates the need for paediatric surgical care in an urban area of sub-Saharan Africa. Seven hundred and forty-one children were treated for surgical problems from January through December 1997. The most common surgical problems were injuries (67.1%), congenital anomalies (15.0%) and surgical infections (6.7%). Forty-six per cent of children presenting with a surgical problem required a surgical procedure, 68.2% of which were classified as minor. The annual presentation rate for all surgical conditions was 543 per 10,000 children aged 0-14 years. The estimated cumulative risk for all surgical conditions is 85.4% by age 15 years. Our data suggest surgical diseases commonly affect children living in Banjul. Surgical care should be an essential component of child health programmes in developing countries.

Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia.

Over the last two decades, the maternal mortality ratio appears to have fallen by up to 50% in the Farafenni, a rural area of The Gambia. This reduction almost certainly reflects improvements in access to essential obstetric services. The ratio, however, is still 50 times higher than in Western and Northern Europe or North America. This paper provides information from a community-based study of 623 women who had recently given birth in the Farafenni area. Information on how, when, and why care was accessed, and what type of care and information were provided were obtained from traditional and western methods of health care were during visits. Women were asked about their experiences during prenatal, delivery and postpartum periods. Results from this study highlight a number of opportunities for improving the quality of maternal health services that could be implemented relatively easily with existing resources.