title: Supportive nurse-midwife care is associated with a reduced incidence of cesarean section.
abstract: OBJECTIVE
  Our purpose was to examine whether care by a certified nurse-midwife, including personal labor support, was associated with a reduced risk of cesarean delivery.
  
  
  METHODS
  A retrospective cohort study comparing 3551 physician-managed patients with 1056 certified nurse-midwife-managed patients in a university hospital with a mixed socioeconomic and ethnic population was performed. Regression analysis was used to estimate the risk of labor abnormalities, diagnosis of fetal distress, and cesarean delivery in patients delivered by a certified nurse-midwife vs a physician and to control for maternal age, race, parity, fetal size, and delivery year. Subjects included were women having at least five prenatal visits who were delivered of term, singleton, liveborn infants without congenital anomalies with occiput presentation.
  
  
  RESULTS
  Odds ratio for cesarean section for women delivered by certified nurse-midwives versus those delivered by physicians was 0.71 (95% confidence interval 0.55, 0.91). Midwifery care was associated with a lower risk of abnormal labor (adjusted odds ratio 0.70, 95% confidence interval 0.60, 0.83) and diagnosis of fetal distress (adjusted odds ratio 0.50, 95% confidence interval 0.32, 0.77).
  
  
  CONCLUSIONS
  This work demonstrates that labor abnormalities and diagnosis of fetal distress are less frequent in patients cared for by nurse-midwives, and there is an association with a lower incidence of cesarean section.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco.
authors.forename: J
authors.initials: J
authors.lastname: Butler
authors.forename: B
authors.initials: B
authors.lastname: Abrams
authors.forename: J
authors.initials: J
authors.lastname: Parker
authors.forename: J M
authors.initials: JM
authors.lastname: Roberts
authors.forename: R K
authors.initials: RK
authors.lastname: Laros
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies