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Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia

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Background: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada. Methods: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n =488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n =572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data. Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group. Conclusions: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity. (BIRTH 34:2 June 2007)
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Keywords: birth; hospital; midwifery; morbidity; obstetrics; pregnancy outcomes

Document Type: Research Article

Affiliations: 1: Elizabeth M. Ryan is a Clinical Assistant Professor in the Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada. 2: Duncan J. Etches is a Clinical Professor and Michael C. Klein is a Professor Emeritus in the Department of Family Practice 3: Patricia A. Janssen is an Associate Professor and Birgit Reime is a Visiting Scholar in the Department of Health Care and Epidemiology

Publication date: June 1, 2007

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