prenatal
Nurse-Midwifery Prototypes Educytion and Clinical Practice to keep their Obstetric unit alive. At the same time, a neighboring satellite clinic, dissatisfied with the intrapartum care their patients were getting at another area hospital, was looking for a new affiliatic n. Encouraged by nurse-midv.%es Grace Berg and Lynn Kugler, :ounders of the clinic, the North Hudson administration decided to affiii:e with the satel-
Editor’s Note: This is the first of o serles of articles on nurse-midwifery practice in different clinical and educational settings. The aim of this standing column will be to put nursemidwiues in touch with what others are dofng around the county: innovations, successes, problem.soluing, 2nd effective ways of providing ser&es. Unsolicited manuscripts describing unique features of a nursemidwifery seruice and/or educational program will be uqelcomed reuiewedfor possible publicdion.
lite clinic and establrsh a nurse-midwifery service to can: ,ior its patients. With the help of ACNM President, Dorothea Lang, the service was begun in September, 1975.
and
The Hospital
Setting
.
North Hudson is a 165.bed volun. tary hospital in an urban, industrial area of New Jersey. fllere are no in terns or residents on its me&p’, .+aff instead, the hospital hires a smal number of “house doctors” to cove1 on nights, weekends, and other time! when attendings are not present. In-hospital fees for the Obstetric clinic patients are arranged on a slid ing scale; Medicaid is accepted, bu Blue Cross/Blue Shield are not, tc avoid competing with private care Prenatal care at the satellite clink i funded by the State Department o Health and is free. The patient community is a mix ture of white, Hispanic, and Black Patients of the nurse-midwifery +erv ice are working class and poo women.
featuring . . . North Hudson Hospital’s Nurse-Midwifery Service Jean
Rafler,
BY C.N.M.,
M.S.
Nurse-midwives at North Hudson Hospttal have established a service shaped by the health needs of the communtty they serve. They funrtion with a high degree of autonomy and self-directfon, and deal with both normal and complicated cases in their
The Nurse-Midwifery
Starting
the Seruice
Like many hospitals, North Hudson faced a declining birth rate in the 1970’s. They needed more patients JOURNAL
OF NURSE-MIDWIFERY
The a
XXII,
nurse-midwives No.
1, Spring
uostnartum/famihr
clinks in the hospital itself. IX&g thek ftrst year of operation, the nurse-midwives cared for 340 patients in clink, and deitvered 242 of these women. Today, they are regkteting over 100 pattents per quarter. The Expanded Role the Nurse-Midwife
of
Probably the most sktktng feature o;thkservicektheexpa&edro!eof the nurse-midwives. Their fun&on k to care for aft Obstekk clink p&enk at North Hudson; except for c IS, they do not “risk out” bb, rather manage the care risk women irl conjunctton with~thek physic&n back-up. For example. a pregnant cardiac would :z seen j&t+ ly by an MD and CNM in hii risk clink, in addttion to having a consultation. Ltkewtse, CNM% do most antepartal vktts on a prev& ous Cesareem Seotkm patlent, s&dule herforafewjotnthighrtskvisik, and schedule her Cesarean. Accordihg to Pat&e Krajewsktz “Ttrese patients are as much ‘ours’ as the nomd ones. ‘Ihe servtce k unique because we fun& as II-mktwives for the care of the normal, and as expert materntty nurses in the care ofthehIghrisk.WhtfetheMDkw&ing orders and managing the hit risk part of the case, expert nu&ng support k really needed by the woman, too.” The North Hudson nurse-midwives see their role as flexiblez to be a prepared person dealing with the health needs of their community. Krajewskt feek strongly that: ‘A wo-,
Service
The nurse-midwifery service i! presently composed of five nurse midwives with one salaried back-u] physician and a rotating “on call schedule of attending physician: Pauline Krajuwski, C.N.M., is Direct0 of the service:
practice.
and
1 I 1
staff 1977
a Iarg
continues partk@%n.” Thestructureofth&rsmaUcommunity hospital requires much b&ependence and tnittative on the part of
hey provide to patients? Krajewski eels that to answer that question, It’s lecemary to look realistically at wealth care in this country: ‘There is I desperate need for people knowladgable about OB in lit&z hospitals,’ she comments. “Our nation isn’t composed of big medical centers with people tripping over each other to do deliveries. Despite our limitations, our approach works, and our results are significantly impressive. All of our outcomes speak for the fact that the job is being well done - despite the fact that our patients, just by the nature of their background, are at risk.”
the nu,e-midwives. Their autonomy is reflected in the fact that they func. tion tithout standing o&rs. Use of traditiond components 0~ intrapartal care smh as the prep, IV. and position for delivery zre determined by the nurse-midwife’s judgment as to what C dppropziate and safe. Krajewski nctesz “The physician does not de+% who is normal and send her to us - we decide who is abnormal and send her to him.. .wh!ch is really .vhat midwifery is dl aboLt. A normal woman doesn’t need to see an MD during her pregnancy.” The absence of interns and residents ~1 the hospital means th::! a nurse-midwife may easily find herself in L&D with a complicated and an attending physician
patient, back-up
Plansfor
Working
34
Together
Kmjewski attributes a large part of the success of the North Hudson nurse-midwifery service to the close and supportive relationships that have developed among the nursemidwives: “The women who have worked here have been very dedicated, concerned, nurturing individ-
1 he biiest proMem for the North H&on nurse-midwives has been physician back-up. In the beginning of the service, all back-up was sup piied by attendings who were re @red to volunteer to be on call foj the OB dink patients. Although the MD’s wanted the OB service to re reco@zed
nurse-mid-
choice of nurse-midwifery care should be open to all women - the richer should not be discriminated against.”
F rublems
and they
Hudson
patients will not be “risked out” of nurse-midwifery care. She feels that: “There’s a growing interest for a nurse-midwifery experience by women in northern New Jersey, and there’s no hospital-based service of any size functioning at this time. The
improve maternal/child healtn in the arzs. They hope to help establish a nutqtion program that could benefit pIealnant women.
open,
North
wives plan to set up a private nursemidwifery service in addition to their clinic service. What kind of service it would be is still under discussion. Krajewski wants to keep the team ap preach they have developed, where
cal center to define your role exactI! - but here, that wouldn’t work.” In addition to their expaded role, the North Hudson nurse-midwives ;lre developing a strong pu’hlic health *component to their work. They see sn important part of their function as ,assisting in health planning and “leaId maintenance in Iheir community. With thii end in mind, they work closely with the local chapter of the American Cancer Society in promoting breast wlf.examination, and with the March of Dimes in trying to
.nain
the Future
The
who may live a substantial distance away. “In a hospitz! this size”, Krajewski comments, “you can’t be a wallflower of normalcy. You can’t just call the physician and say ‘I’ve got this complkaied lady’ and then sit back with your hands folded until he arrives. It’s nice in a big medi.
uals. All have been goal-oriented, and willing to take on a lot of responsibility.” “Working with nurse-midwives is IuCe working with no other group of people,” she concludes. “Everyone is helping each other to reach for what could be the best.”
tha JOURNAL
OR NURSE-MIDWIFERY
l
Vol.
XXII,
No. 1. Spring
1977
Nurse-Midwifery Prototypes Educytion and Clinical Practice to keep their Obstetric unit alive. At the same time, a neighboring satellite clinic, dissatisfied with the intrapartum care their patients were getting at another area hospital, was looking for a new affiliatic n. Encouraged by nurse-midv.%es Grace Berg and Lynn Kugler, :ounders of the clinic, the North Hudson administration decided to affiii:e with the satel-
Editor’s Note: This is the first of o serles of articles on nurse-midwifery practice in different clinical and educational settings. The aim of this standing column will be to put nursemidwiues in touch with what others are dofng around the county: innovations, successes, problem.soluing, 2nd effective ways of providing ser&es. Unsolicited manuscripts describing unique features of a nursemidwifery seruice and/or educational program will be uqelcomed reuiewedfor possible publicdion.
lite clinic and establrsh a nurse-midwifery service to can: ,ior its patients. With the help of ACNM President, Dorothea Lang, the service was begun in September, 1975.
and
The Hospital
Setting
.
North Hudson is a 165.bed volun. tary hospital in an urban, industrial area of New Jersey. fllere are no in terns or residents on its me&p’, .+aff instead, the hospital hires a smal number of “house doctors” to cove1 on nights, weekends, and other time! when attendings are not present. In-hospital fees for the Obstetric clinic patients are arranged on a slid ing scale; Medicaid is accepted, bu Blue Cross/Blue Shield are not, tc avoid competing with private care Prenatal care at the satellite clink i funded by the State Department o Health and is free. The patient community is a mix ture of white, Hispanic, and Black Patients of the nurse-midwifery +erv ice are working class and poo women.
featuring . . . North Hudson Hospital’s Nurse-Midwifery Service Jean
Rafler,
BY C.N.M.,
M.S.
Nurse-midwives at North Hudson Hospttal have established a service shaped by the health needs of the communtty they serve. They funrtion with a high degree of autonomy and self-directfon, and deal with both normal and complicated cases in their
The Nurse-Midwifery
Starting
the Seruice
Like many hospitals, North Hudson faced a declining birth rate in the 1970’s. They needed more patients JOURNAL
OF NURSE-MIDWIFERY
The a
XXII,
nurse-midwives No.
1, Spring
uostnartum/famihr
clinks in the hospital itself. IX&g thek ftrst year of operation, the nurse-midwives cared for 340 patients in clink, and deitvered 242 of these women. Today, they are regkteting over 100 pattents per quarter. The Expanded Role the Nurse-Midwife
of
Probably the most sktktng feature o;thkservicektheexpa&edro!eof the nurse-midwives. Their fun&on k to care for aft Obstekk clink p&enk at North Hudson; except for c IS, they do not “risk out” bb, rather manage the care risk women irl conjunctton with~thek physic&n back-up. For example. a pregnant cardiac would :z seen j&t+ ly by an MD and CNM in hii risk clink, in addttion to having a consultation. Ltkewtse, CNM% do most antepartal vktts on a prev& ous Cesareem Seotkm patlent, s&dule herforafewjotnthighrtskvisik, and schedule her Cesarean. Accordihg to Pat&e Krajewsktz “Ttrese patients are as much ‘ours’ as the nomd ones. ‘Ihe servtce k unique because we fun& as II-mktwives for the care of the normal, and as expert materntty nurses in the care ofthehIghrisk.WhtfetheMDkw&ing orders and managing the hit risk part of the case, expert nu&ng support k really needed by the woman, too.” The North Hudson nurse-midwives see their role as flexiblez to be a prepared person dealing with the health needs of their community. Krajewskt feek strongly that: ‘A wo-,
Service
The nurse-midwifery service i! presently composed of five nurse midwives with one salaried back-u] physician and a rotating “on call schedule of attending physician: Pauline Krajuwski, C.N.M., is Direct0 of the service:
practice.
and
1 I 1
staff 1977
a Iarg
continues partk@%n.” Thestructureofth&rsmaUcommunity hospital requires much b&ependence and tnittative on the part of
hey provide to patients? Krajewski eels that to answer that question, It’s lecemary to look realistically at wealth care in this country: ‘There is I desperate need for people knowladgable about OB in lit&z hospitals,’ she comments. “Our nation isn’t composed of big medical centers with people tripping over each other to do deliveries. Despite our limitations, our approach works, and our results are significantly impressive. All of our outcomes speak for the fact that the job is being well done - despite the fact that our patients, just by the nature of their background, are at risk.”
the nu,e-midwives. Their autonomy is reflected in the fact that they func. tion tithout standing o&rs. Use of traditiond components 0~ intrapartal care smh as the prep, IV. and position for delivery zre determined by the nurse-midwife’s judgment as to what C dppropziate and safe. Krajewski nctesz “The physician does not de+% who is normal and send her to us - we decide who is abnormal and send her to him.. .wh!ch is really .vhat midwifery is dl aboLt. A normal woman doesn’t need to see an MD during her pregnancy.” The absence of interns and residents ~1 the hospital means th::! a nurse-midwife may easily find herself in L&D with a complicated and an attending physician
patient, back-up
Plansfor
Working
34
Together
Kmjewski attributes a large part of the success of the North Hudson nurse-midwifery service to the close and supportive relationships that have developed among the nursemidwives: “The women who have worked here have been very dedicated, concerned, nurturing individ-
1 he biiest proMem for the North H&on nurse-midwives has been physician back-up. In the beginning of the service, all back-up was sup piied by attendings who were re @red to volunteer to be on call foj the OB dink patients. Although the MD’s wanted the OB service to re reco@zed
nurse-mid-
choice of nurse-midwifery care should be open to all women - the richer should not be discriminated against.”
F rublems
and they
Hudson
patients will not be “risked out” of nurse-midwifery care. She feels that: “There’s a growing interest for a nurse-midwifery experience by women in northern New Jersey, and there’s no hospital-based service of any size functioning at this time. The
improve maternal/child healtn in the arzs. They hope to help establish a nutqtion program that could benefit pIealnant women.
open,
North
wives plan to set up a private nursemidwifery service in addition to their clinic service. What kind of service it would be is still under discussion. Krajewski wants to keep the team ap preach they have developed, where
cal center to define your role exactI! - but here, that wouldn’t work.” In addition to their expaded role, the North Hudson nurse-midwives ;lre developing a strong pu’hlic health *component to their work. They see sn important part of their function as ,assisting in health planning and “leaId maintenance in Iheir community. With thii end in mind, they work closely with the local chapter of the American Cancer Society in promoting breast wlf.examination, and with the March of Dimes in trying to
.nain
the Future
The
who may live a substantial distance away. “In a hospitz! this size”, Krajewski comments, “you can’t be a wallflower of normalcy. You can’t just call the physician and say ‘I’ve got this complkaied lady’ and then sit back with your hands folded until he arrives. It’s nice in a big medi.
uals. All have been goal-oriented, and willing to take on a lot of responsibility.” “Working with nurse-midwives is IuCe working with no other group of people,” she concludes. “Everyone is helping each other to reach for what could be the best.”
tha JOURNAL
OR NURSE-MIDWIFERY
l
Vol.
XXII,
No. 1. Spring
1977
