Midwives and obstetrician-gynecologists collaborating for Native American women's health.

Certified Nurse-Midwives (CNMs) and Obstetrician-Gynecologists (OBGs) have a long history of successful collaborative practice serving Native American women from the 1960s. CNMs provide holistic, patient-centered care focusing on normal pregnancy and childbirth. OBGs support CNMs with consultation services focusing on complications during pregnancy and specialty gynecology care. Collaborative care in Indian Health Service and Tribal sites optimizes maternity care in a supportive environment, achieving excellent outcomes including low rates of cesarean deliveries and high rates of successful vaginal birth after cesarean.

Emergency contraception availability in New Mexico: impact of direct pharmacy access.

OBJECTIVES: To assess the impact of direct pharmacy access to emergency contraception (EC) and availability of EC in Albuquerque and rural New Mexico and to compare availability of EC in Albuquerque with that estimated in a 2002 study. DESIGN: Investigational study. SETTING: Albuquerque and rural New Mexico, between March and September 2005. PARTICIPANTS: 121 community pharmacies (94 in Albuquerque and 27 in rural New Mexico). INTERVENTIONS: Research assistants visited pharmacies and followed a predetermined script during interviews with pharmacy staff. MAIN OUTCOME MEASURES: Availability of EC with and without an advance prescription; other factors related to EC access. RESULTS: EC was available in 50% of both Albuquerque and rural pharmacies. EC was available without an advance prescription in 13% of pharmacies. The medication was more likely to be in stock at pharmacies with an EC-certified pharmacist on staff (92%) than in those without an EC-certified pharmacist (39%) (P < 0.001). A study performed in 2002 reported that EC was in stock during 11% of visits to Albuquerque pharmacies, whereas the current study reported EC being available during 50% of visits. CONCLUSION: At the time of this study, EC availability was similar in both Albuquerque and rural New Mexico pharmacies, and pharmacies with trained pharmacists on staff were more likely to stock EC medications.

Obstetrics and gynecology residents as teachers of medical students: predictors of excellence.

OBJECTIVE: The purpose of this study was to assess variables that might predict which intern candidates will become excellent teachers of medical students. STUDY DESIGN: This retrospective cohort study compared demographic characteristics, previous work experience, United States Medical Licensing Examinations scores, honors on core clerkships, membership in Alpha Omega Alpha, and match list ranking of 43 residents to identify predictors of excellent teaching evaluations during residency. RESULTS: Fifteen residents (35%) were identified as excellent teachers. They were more likely to have had previous work experience, to be older, or to be male. They were not more likely to have higher United States Medical Licensing Examinations test scores, more honors grades, Alpha Omega Alpha membership, or a higher rank list position. CONCLUSION: Work experience, age, and male gender are associated with increased likelihood of being identified as an excellent teacher by medical students. Programs in which residents have a significant role as teachers of students may consider these factors in the residency selection process.

Barriers to intrauterine device insertion in postpartum women.

OBJECTIVE: The objective of this study was to determine the proportion of postpartum women at the University of New Mexico who choose an IUD for contraception, the number who actually obtain one and the barriers to postpartum IUD insertion. METHOD: We conducted a retrospective chart review of 1627 postpartum women who delivered at the University of New Mexico. Those women who indicated at hospital discharge that they desired an IUD comprised the study group of 193 women. Medical records were reviewed to identify the timing of IUD placement. If an IUD was not inserted, we attempted to determine the reason by reviewing clinic records. RESULTS: Twelve percent of postpartum women requested an IUD. Records were available for 114 women. Of these, only 69 (60%) actually obtained an IUD. Barriers to postpartum IUD insertion included provider advice against the IUD, patient failure to return for a postpartum visit and early repeat pregnancy. CONCLUSION: We conclude that postpartum women desiring an IUD may have difficulty obtaining one.