A Retrospective Study of Low-Risk Cesarean Delivery by Midwife Versus Obstetrician Service [02P

Abstract

INTRODUCTION: To evaluate the variation in low risk cesarean delivery rate between the midwife and obstetrician-led services at a rural tertiary care center. METHODS: A retrospective cohort study of 1787 term, singleton, and vertex (TSV) deliveries without a history of cesarean delivery at a rural academic tertiary care center was performed. The primary outcome was rate of cesarean delivery among midwife and obstetrician-led services. Statistical comparisons were performed using student t-tests, chi-square tests, and multivariable logistic regression. RESULTS: Between January 2015 and December 2017, 1787 deliveries were analyzed with 956 (53%) managed by the midwife service and 831 (47%) managed by the obstetrician-led service. Midwife patients had significantly lower odds of having a cesarean delivery after adjustment for all maternal and delivery characteristics (aOR 0.56, 95% CI 0.30–0.82). Other factors favoring cesarean delivery include older maternal age, higher body mass index at delivery, and nulliparity. Midwife patients had higher odds of presenting in spontaneous labor (63.0% vs 53.3%, P<.001), while obstetrician patients had increased odds of receiving neuraxial anesthesia (72.3% vs 56.1%, P<.001) and were more likely to be nulliparous (56.4% vs. 50.3%, P=.01). There were no differences in frequency of APGAR scores less than 7 at five minutes between the two groups (2.5% for obstetrician vs. 1.7% for midwife, P=.204). CONCLUSION: In this rural academic tertiary care center, patients cared for by the midwife service have significantly lower odds of cesarean delivery than patients cared for by the physician-led service after adjustment for patient demographics and maternal medical conditions.