Two practice models in one labor and delivery unit: association with cesarean delivery rates - 02/04/15
, Sanae Nakagawa, MA b, Yvonne Cheng, MD, PhD d, eAbstract |
Objective |
The objective of the study was to examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital.
Study Desgin |
This was a retrospective cohort study of 9381 singleton live births at 1 community hospital, at which women were provided labor and delivery care under 1 of 2 distinct practice models: a traditional private practice model and a midwife-physician laborist practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the χ2 test and multivariable logistical regression.
Results |
Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%; P < .001; adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.73–2.58). Women with nulliparous, term, singleton, vertex gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% vs 15.9%; P < .001; aOR, 1.86; 95% CI, 1.33–2.58) as were women who had a prior cesarean delivery (71.3% vs 41.4%; P < .001; aOR, 3.19; 95% CI, 1.74–5.88).
Conclusion |
In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.
Le texte complet de cet article est disponible en PDF.Key words : cesarean delivery, labor and delivery practice, midwife-physician laborist practice, private practice
Plan
| The views expressed herein are those of the authors and do not necessarily represent the official views of the National Institutes of Health. |
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| This study was supported in part by the National Center for Advancing Translational Sciences, National Institutes of Health, through a grant from the San Francisco Bay Collaborative Research Network and grant K12 HD001262 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. |
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| The authors report no conflict of interest. |
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| Cite this article as: Nijagal MA, Kuppermann M, Nakagawa S, et al. Two practice models in one labor and delivery unit: association with cesarean delivery rates. Am J Obstet Gynecol 2015;212:491.e1-8. |
Vol 212 - N° 4
P. 491.e1-491.e8 - avril 2015 Retour au numéro
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