title: Interspecialty differences in the obstetric care of low-risk women.
abstract: OBJECTIVE
  This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients.
  
  
  METHODS
  For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted.
  
  
  RESULTS
  Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians.
  
  
  CONCLUSIONS
  The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.
authors.affiliation: Department of Family Medicine, University of Washington School of Medicine, Seattle 98195-4795, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: S A
authors.initials: SA
authors.lastname: Dobie
authors.forename: L G
authors.initials: LG
authors.lastname: Hart
authors.forename: R
authors.initials: R
authors.lastname: Schneeweiss
authors.forename: D
authors.initials: D
authors.lastname: Gould
authors.forename: T R
authors.initials: TR
authors.lastname: Raine
authors.forename: T J
authors.initials: TJ
authors.lastname: Benedetti
authors.forename: M J
authors.initials: MJ
authors.lastname: Pirani
authors.forename: E B
authors.initials: EB
authors.lastname: Perrin
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D009721:Nurse Midwives / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D014481:United States; D014861:Washington