Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.
CONCLUSION: Data on sterilization regret and motivations could be hindered by literacy and biased questioning. A novel, pretested survey tool oriented toward inclusive and comprehensive language is needed to capture female sterilization trends.
INTRODUCTION:
We sought to determine if parity and starting effacement predict successful induction of labor (IOL), defined as achievement of complete cervical dilation (ACD), when utilizing Foley Balloon (FB) for IOL.
METHODS:
A retrospective study with IRB approval was conducted of all singleton pregnancies undergoing IOL between 2013 and 2016 at a single institution. Stillbirths and prior cesarean delivery (CD) were excluded. Primary outcome was ACD. Secondary outcomes were CD, postpartum hemorrhage, chorioamnionitis, and NICU admission. Starting effacement was stratified into quartiles: 0-25%, 26-50%, 51-75%, and 76-100%, and parity divided into nulliparous and multiparous groups. Multivariate logistic regression were performed to assess the effect of parity and starting effacement on the rate of ACD.
RESULTS:
Of the 1,260 patients that met inclusion criteria, 615 had starting effacement between 0-25% with a mean parity of 1.0. In nulliparous women with starting effacement 0-25% receiving FB for IOL, 50.4% (68) ACD, compared to 69.0% (116) in the same group not receiving FB (P<0.001, OR 0.45; 95th CI: 0.28-0.73). The CD rate was also higher in nulliparous women receiving FB (54.8% v 34.9%, P<0.001, OR: 2.3; 95th CI: 1.4-3.6) compared to nulliparous women not receiving FB. In multiparous women with starting effacement 0-25% receiving FB for IOL, 84.8% (56) ACD, compared to 86.2% (219) in the same group not receiving FB (P=0.69, OR 0.86; 95th CI: 0.4-1.8). There were no statistically significant differences in the secondary outcomes.
CONCLUSION:
Nulliparous patients with low starting effacement may benefit from additional medications, rather than placement of FB for IOL.
the last 60-90min. Given concerns about the safety of uterine overstimulation, we need to determine whether the supraphysiologic intrauterine pressures generated in augmented labor are necessary to achieve a vaginal delivery.
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