The Association of Expanded Access to a Collaborative Midwifery and Laborist Model With Cesarean Delivery Rates

Obstetrics and Gynecology
Melissa G RosensteinMiriam Kuppermann

Abstract

To examine the association between expanded access to collaborative midwifery and laborist services and cesarean delivery rates. This was a prospective cohort study at a community hospital between 2005 and 2014. In 2011, privately insured women changed from a private practice model to one that included 24-hour midwifery and laborist coverage. Primary cesarean delivery rates among nulliparous, term, singleton, vertex women and vaginal birth after cesarean delivery (VBAC) rates among women with prior cesarean delivery were compared before and after the change. Multivariable logistic regression models estimated the effects of the change on the odds of primary cesarean delivery and VBAC; an interrupted time-series analysis estimated the annual rates before and after the expansion. There were 3,560 nulliparous term singleton vertex deliveries and 1,324 deliveries with prior cesarean delivery during the study period; 45% were among privately insured women whose care model changed. The primary cesarean delivery rate among these privately insured women decreased after the change, from 31.7% to 25.0% (P=.005, adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.39-0.81). The interrupted time-series analysis estimated a 7% drop ...Continue Reading

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Citations

Feb 29, 2016·American Journal of Obstetrics and Gynecology·Torri D MetzJ Christopher Carey
Sep 4, 2016·American Journal of Obstetrics and Gynecology·Lynn M YeeWilliam A Grobman
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