Leslie Cragin1, Holly Powell Kennedy. 1. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94110, USA. craginl@obgyn.ucsf.edu
Abstract
OBJECTIVE: To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN: Prospective descriptive cohort design. SETTING: A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS: Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES: The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS: Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION: Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.
OBJECTIVE: To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN: Prospective descriptive cohort design. SETTING: A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS: Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES: The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS: Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION: Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.