Do women choose their obstetric providers based on risks at entry into prenatal care? A study of women in Washington State.
OBJECTIVE
To study risk factors in a large population of women over a broad geographic area as they entered obstetric care, and to assess how they distributed themselves among the specialties.


METHODS
Data from 1 year were gathered through a retrospective chart review of all women initiating care with randomly selected urban and rural obstetricians, urban and rural family physicians, and urban certified nurse midwives.


RESULTS
The majority of women had at least one risk factor at entry into care. When a scoring system was applied to the data, 13.5% of the women were designated "high risk," which is consistent with findings of other studies. However, women did not distribute themselves to provider types according to risk. Higher-risk women were more likely to choose family physicians, especially in rural areas. Much of this difference can be attributed to young maternal age, late entry into care, and lack of health insurance or Medicaid sponsorship.


CONCLUSIONS
These findings suggest that economics and geography are more likely to influence a woman's initial choice of provider than medical and obstetric risk.
Dobie
S A
SA
Department of Family Medicine, University of Washington, Seattle.
Hart
L G
LG
Fordyce
M
M
Rosenblatt
R A
RA
D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D005194:Family Practice / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives / Q000592:standards; D009774:Obstetrics; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population; D014861:Washington