Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women

A Consortium on Safe Labor study

Nicole S. Carlson, Jeremy L. Neal, Ellen Tilden, Denise C. Smith, Rachel B. Breman, Nancy K. Lowe, Mary S. Dietrich, Julia C. Phillippi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.

Original languageEnglish (US)
JournalBirth
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Midwifery
Vaginal Birth after Cesarean
Parturition
Induced Labor
Odds Ratio
Logistic Models
Perinatal Care
Propensity Score
Birth Rate
Health Insurance
Population
Cohort Studies
Retrospective Studies
Mothers

Keywords

  • cesarean
  • culture
  • induced labor
  • midwifery
  • multiparous
  • obstetrics
  • oxytocin
  • parturition

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women : A Consortium on Safe Labor study. / Carlson, Nicole S.; Neal, Jeremy L.; Tilden, Ellen; Smith, Denise C.; Breman, Rachel B.; Lowe, Nancy K.; Dietrich, Mary S.; Phillippi, Julia C.

In: Birth, 01.01.2018.

Research output: Contribution to journalArticle

Carlson, Nicole S. ; Neal, Jeremy L. ; Tilden, Ellen ; Smith, Denise C. ; Breman, Rachel B. ; Lowe, Nancy K. ; Dietrich, Mary S. ; Phillippi, Julia C. / Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women : A Consortium on Safe Labor study. In: Birth. 2018.
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abstract = "Background: Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85{\%} less likely to have labor induced (risk ratio [RR] 0.15; 95{\%} CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36{\%} lower at interprofessional centers (RR 0.64; 95{\%} CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31{\%} higher (RR 1.31; 95{\%} CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.",
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AU - Neal, Jeremy L.

AU - Tilden, Ellen

AU - Smith, Denise C.

AU - Breman, Rachel B.

AU - Lowe, Nancy K.

AU - Dietrich, Mary S.

AU - Phillippi, Julia C.

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N2 - Background: Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.

AB - Background: Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.

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KW - multiparous

KW - obstetrics

KW - oxytocin

KW - parturition

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