Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes - 21/11/12

Doi : 10.1503/cmaj.111753

Susan J. Harris, MD ^a,^f, Patricia A. Janssen, PhD ^a,^b,^c,^d,^e,^g,^⁎ , Lee Saxell, MA ^f, Elaine A. Carty, MSN ^b,^d, George S. MacRae, MN ^h, Karen L. Petersen, BEd ^e

^a Department of Family Practice, University of British Columbia, Vancouver, BC

^b Division of Midwifery, University of British Columbia, Vancouver, BC

^c School of Population and Public Health, University of British Columbia, Vancouver, BC

^d School of Nursing, University of British Columbia, Vancouver, BC

^e Department of Experimental Medicine, University of British Columbia, Vancouver, BC

^f BC Women’s Hospital and Health Centre, Vancouver, BC

^g Child and Family Research Institute, Vancouver, BC

^h Provincial Health Services Authority, Vancouver, BC

^* Correspondence to: Patricia A. Janssen

Contributors: Susan Harris, Patricia Janssen, Lee Saxell and Elaine Carty conceptualized and designed this study. Analysis of data was undertaken by Patricia Janssen, George MacRae and Karen Petersen. Before her death in 2009, Susan Harris contributed to the methods and collaborated in the writing of the manuscript. The manuscript has since been developed collaboratively, and Patricia Janssen, Lee Saxell, Elaine Carty, George MacRae and Karen Petersen have read and approved the final manuscript submitted for publication.

Abstract

Background

The number of physicians providing maternity care in Canada is decreasing, and the rate of cesarean delivery is increasing. We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Methods

We conducted a retrospective cohort study involving 1238 women who attended the South Community Birth Program in Vancouver, Canada, from April 2004 to October 2010. The program offers comprehensive, collaborative, interdisciplinary care from family physicians, midwives, community health nurses and doulas to a multiethnic, low-income population. A comparison group, matched for neighbourhood of residence, maternal age, parity and gestational age at delivery, comprised 1238 women receiving standard care in community-based family physician, obstetrician and midwife practices. The primary outcome was the proportion of women who underwent cesarean delivery.

Results

Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68–0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25−4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85−2.39).

Interpretation

Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

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Plan

Methods

Setting

South Community Birth Program

Competing interests: None declared.
This article has been peer reviewed.
Funding: The study was funded by the Canadian Federal Primary Health Care Transition Fund and the Provincial Health Services and Vancouver Coastal Health Authorities in British Columbia. The study sponsors had no role in the design of the study, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the article for publication.