Nurse midwives, who assist families at the Pine Ridge Indian Hospital, a federally funded health care facility, have been able to greatly avoid many of the interventions that plague many other hospitals throughout the country. In 2006 at this hospital, eighty-five percent of the 375 births were attended by nurse midwives who were not required to have a collaborative agreement as they are in other hospitals in South Dakota. The clients were Native American women with a variety of socio- economic and medical risk factors. Their babies tended to be larger and the gestational diabetes rate was 2-3 times higher than the national average. Despite these challenges, midwives still experienced very low intervention rates.
? No epidurals for vaginal births
? 73% of vaginal births had no lacerations
? 76% with lacerations were minor (first
degree or superficial abrasions)
? 1 fourth degree (occurred with vacuum), no
thirds
? Approximately 5 total episiotomies
? 1 vacuum, no forceps
? 7.2% primary Cesarean rate
? 16.5% total overall Cesarean rate (no trial of
labor for repeat sections offered that year)