Exploration of Nurse-Midwifery Care for Childbirth
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Pregnancy and childbirth contribute to approximately one in four hospitalizations, often involving multiple elective and expensive interventions such as labor analgesia, labor induction, or cesarean delivery, adding to health care utilization and cost burden. Obstetrical care provided by certified nurse-midwives (CNMs) for women with low-risk pregnancies has been considered as safe as comparable care provided by obstetrician/gynecologists (OB/GYNs), and may also lead to significant cost savings. There is a critical need to comparatively examine healthcare system outcomes and maternal-neonatal outcomes by type of obstetric provider in U.S. hospitals. This retrospective observational study examined maternal and neonatal outcomes as well as hospital delivery system outcomes for 1,013 medically low-risk women who gave birth to an infant during the year 2013 at a large hospital in the Pacific Northwest by either a CNM or an OB/GYN. Multivariable and multi-level analysis methods were used to assess differences in outcomes by provider group.Women who were attended by a CNM had comparable maternal and neonatal outcomes, with overall lower intervention use, lower utilization of hospital resources, and lower cost than care provided by OB/GYNs. Multi-level modeling demonstrated a clustering effect by provider for several interventions. This study contributes evidence that care by CNMs may be a cost-effective and high quality alternative to the existing physician-led model. The use of multi-level modeling in the study demonstrates a need to control for differences in provider practice when examining intervention use in health science research.