Interspecialty differences in the obstetric care of low-risk women.
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.
Rosenblatt
R A
RA
Department of Family Medicine, University of Washington School of Medicine, Seattle 98195-4795, USA.
Dobie
S A
SA
Hart
L G
LG
Schneeweiss
R
R
Gould
D
D
Raine
T R
TR
Benedetti
T J
TJ
Pirani
M J
MJ
Perrin
E B
EB
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