What's in a Name? Provider Type and Delivery Outcomes for Nulliparous, Term, Singleton, Vertex Pregnancies in an Urban Hospital [ID 2683515

Abstract

INTRODUCTION: Few studies have compared the rates of cesarean section of nulliparous, term, singleton, vertex (NTSV) pregnancies between those managed by physicians and those managed by midwives. Our aim was to compare those rates and to determine whether there were any associated differences in neonatal outcomes. METHODS: This was a retrospective cohort study of NTSV pregnancies at an urban hospital over 3 months. Two groups were compared: patients who were managed by physicians and those managed by midwives. Our primary outcome was the rate of primary cesarean delivery for each group. Patient demographics and outcomes were compared using a χ2 analysis for categorical variables and Mann–Whitney U test for continuous variables, with significance being alpha <.05. Our study was approved by the Maimonides IRB. RESULTS: Between January and March 2023, there were 315 NTSV deliveries. Of these, 230 (73%) were admitted by physicians and 85 by certified nurse-midwives (27%). The NTSV patients admitted and managed by physicians were significantly more likely to undergo cesarean delivery (30.9% versus 16.5%; P=.01). This trend remains significant (P=.04) when adjusted for high-risk maternal comorbidities (ie, diabetes, hypertension, and maternal body mass index). There were no significant differences of neonatal outcomes between physician and midwives groups in Apgar scores (1 minute P=.43, 5 minutes P=.19), neonatal intensive care unit (NICU) admissions (P=.84), or NICU stay length (P=.89). CONCLUSION: The NTSV pregnancies managed by midwives resulted in fewer cesarean deliveries with similar neonatal outcomes. Further investigation is needed to assess causes of the difference between provider types and to develop interventions to address the discrepancy.