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Progression of care among women who use a midwife for prenatal care: Who remains in midwife care?
Author(s) -
Weisband Yiska Loewenberg,
Gallo Maria F.,
Klebanoff Mark A.,
Shoben Abigail B.,
Norris Alison H.
Publication year - 2018
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12308
Subject(s) - prenatal care , medicine , pregnancy , obstetrics , logistic regression , family medicine , medical record , odds ratio , odds , retrospective cohort study , nursing , population , environmental health , genetics , radiology , pathology , biology
Background Prenatal care provided by midwives provides a safe and cost‐effective alternative to care provided by physicians. However, no studies have evaluated the frequency of women who leave midwifery care, in a hospital setting. Our study objectives were to measure the frequency of transfers of care to physicians, to describe the sociodemographic and pregnancy‐related characteristics of women who transferred to the care of a physician during prenatal care and at delivery, and to assess correlates of these transfers. Methods We used electronic medical records to perform a retrospective cohort study of women who delivered at The Ohio State University Wexner Medical Center ( OSUWMC ) and had at least one prenatal care visit within OSUWMC 's network. We report descriptive findings, using proportions and means with standard deviations. We used logistic regression, with Firth's bias correction as necessary, to assess correlates of transferring to a physician during prenatal care and at delivery. Results Most women who initiated prenatal care with a midwife remained in midwifery care throughout delivery, with 4.7% transferring to a physician during prenatal care, and an additional 21.4% transferring to a physician during delivery. After adjusting for pregnancy‐related factors, the black race was statistically significantly associated with leaving midwifery care during prenatal care (adjusted odds ratio AOR 3.0 [95% CI 1.4–6.6]) and delivery ( AOR 2.5 [95% CI 1.5–4.3]). Conclusion Findings indicate that most women remain in midwifery care throughout pregnancy, but raise important questions with respect to the possible role that race has in pregnancy care.