Interspecialty differences in the obstetric care of low-risk women

• Published in: American journal of public health (1971) Vol. 87; no. 3; pp. 344 - 351
• Main Authors: Rosenblatt, R A, Dobie, S A, Hart, L G, Schneeweiss, R, Gould, D, Raine, T R, Benedetti, T J, Pirani, M J, Perrin, E B
• Format: Journal Article
• Language: English
• Published: Washington, DC Am Public Health Assoc 01-03-1997; American Public Health Association
• Subjects: Adult; Aged; Biological and medical sciences; Care; Certified nurse-midwives; Cesarean section; Childbirth & labor; Family Practice - statistics & numerical data; Female; Health Care Surveys; Health participants; Health risk assessment; Humans; Medical sciences; Middle Aged; Midwifery; Nurse Midwives - statistics & numerical data; Obstetrics; Obstetrics - statistics & numerical data; Patient satisfaction; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy; Pregnancy Outcome; Pregnant women; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States; Urban areas; Washington; Washington State; Women; Womens health; United States; North America; America; Washington; Human; Health staff; General practitioner; Physician; Risk; Obstetrics; Care; Pregnancy; Low; Professional practice; Behavior; Woman; Midwife; Medical specialty; Comparative study; Public health
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.87.3.344

This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients.
For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted.
Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians.
The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.