Recorded presentation

Jeanne Raisler, DrPH, CNM, FACNM, Nurse-Midwifery Program, University of Michigan School of Nursing, 400 North Ingalls, Rm 3320, Ann Arbor, MI 48109-0482, 734.763.3218, jraisler@umich.edu and Sean Blackwell, MD, Department of Obstetrics & Gynecology, Wayne State University College of Medicine, 4707 St. Antoine, 5 Center Hutzel Hospital, Detroit, MI 48201.

Background: Hospital-based midwives and physicians manage labor differently, and several studies have documented differences in their outcomes of care, even when social and medical risk factors are carefully controlled for. Some studies find that while midwives use fewer interventions during labor, their patients are more likely to have spontaneous vaginal births and better or equal infant outcomes. However, others conclude that good midwife outcomes result from selection bias of lower-risk patients to midwifery care, and that differences become insignificant when patient risk factors are taken into account. Methods: This retrospective comparison study analyzed 5 years of data from ~ 19,000 births at a busy urban hospital that serves mostly low income, African American patients. Stringent criteria were applied to ensure the comparability of midwife and obstetrician patient groups. Data were analyzed on an intent-to-treat basis. Multiple logistic regression was used to calculate odds rations of birth outcomes, neonatal outcomes, and maternal outcomes, while controlling for confounding factors and interactions. Results: Study results will be presented regarding the association of medical procedures used during labor (such as induction, anesthesia, and continuous electronic fetal monitoring) by the two groups of care providers with birth outcomes, including cesarean section, operative vaginal birth, episiotomy/lacerations, and newborn outcomes. Conclusions: In this large sample of mixed-risk, low income urban women, midwife patients used less medication and received fewer interventions during labor than physician patients, and they were less likely to have cesarean sections, operative vaginal deliveries, or postpartum morbidity. Possible explanations for these findings are discussed.

Learning Objectives:

• Discuss the differential use of induction of labor and continuous electronic fetal monitoring by obstetricians and midwives in a mixed-risk sample of urban women.
• Describe the association of obstetric interventions with maternal race, age and health insurance coverage in the sample.
• Explain why hospital-based midwives need to be involved and vigilant regarding institutional data collection regarding their practice.

Keywords: Midwifery, Birth Outcomes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation