228070 Exploring the relationship between CNM-attended births and primary cesarean delivery rates in Massachusetts hospitals

Sunday, November 7, 2010

Kristen Kamp, Graduate Student, Boston University School of Public Health, Dept of Maternal and Child Health , Department of Maternal and Child Health, Boston University, School of Public Health, Boston, MA
Eugene Declercq, PhD , Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA
Background: The increasing number of cesarean deliveries has lead to concern over potential negative health impacts on mothers and infants. Certified nurse midwives (CNMs) attend about 7% of all U.S. births and prior research, done in the 1990s in a single hospital, suggested the use of CNMs in a hospital setting can reduce the cesarean rate.

Methods: Using 1998 to 2006 Massachusetts data from the Pregnancy to Early Life Longitudinal linked birth certificate and hospital discharge database, this study explores the relationship between CNM-attended births and primary cesarean deliveries in all Massachusetts hospitals, controlling for possible modifiers. This study will include a cross-sectional comparison across hospitals; trend analysis of CNM-attended births and hospital cesarean rates; multivariate analysis of the likelihood of any relationship between rates of CNM use and primary cesarean rates; and specific examination of Massachusetts hospitals that eliminated or curtailed CNM services.

Results: Between 1998 and 2006 Massachusetts experienced a rise in primary cesarean rates from 13.8% to 20.6%. In the same period, CNM-attended births remained steady at about 13%. CNM-attended birth rates and cesarean rates varied widely by individual hospital, but there was an overall negative correlation (r=-.34) between the rate of CNM deliveries and the primary cesarean rate in a hospital. Preliminary multivariate analysis also suggests a negative relationship after controlling for maternal demographic and health characteristics.

Conclusions: Preliminary analysis finds that the more heavily a hospital relies on CNMs to do deliveries, the lower their primary cesarean rate.

Learning Areas:
Public health or related research

Learning Objectives:
1. Analyze the relationship between CNM-attended births and primary cesarean delivery rates. 2. Compare trends in hospitals that eliminated or decreased CNM services and articulate the relationship between CNM-attended births and primary cesarean delivery rates. 3. Evaluate the effect of CNM-care on primary cesarean delivery rates.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a graduate student at Boston University in the Department of Maternal and Child Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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