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The effect of midwifery care on rates of cesarean delivery
Author(s) -
Lawton Beverley A.,
Koch Abby,
Stanley James,
Geller Stacie E.
Publication year - 2013
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2013.06.033
Subject(s) - medicine , poisson regression , cesarean delivery , obstetrics , confidence interval , pregnancy , demography , population , environmental health , sociology , biology , genetics
Objective To examine whether changing to a midwifery‐led maternity service model was associated with a lower national rate of cesarean delivery. Methods We analyzed trends in the rate of cesarean delivery per 1000 live births between 1996 and 2010 in New Zealand. Estimates of relative increases in rate were calculated via Poisson regression for several maternal age groups over the study period. Results Rates of cesarean delivery increased over the study period, from 156.9 per 1000 live births in 1996 to 235 per 1000 in 2010: a crude increase of 49.8%. Increasing trends were apparent in each age group, with the largest increases occurring before 2003 and relatively stable rates in the subsequent period. The smoothed estimate showed that the increase in cesarean rate across all age groups was 43.7% (95% confidence interval, 41.6–45.8) over the 15‐year period. Conclusion A national midwifery‐led care model was not associated with a decreased rate of cesarean delivery but, instead, with an increase similar to that in other high‐resource countries. This indicates that other factors may account for the increase. Further research is needed to examine maternity outcomes associated with different models of maternity care.