title: Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia.
abstract: BACKGROUND
  The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada.
  
  
  METHODS
  All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data.
  
  
  RESULTS
  Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group.
  
  
  CONCLUSIONS
  A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.
authors.affiliation: Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Janssen
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ryan
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Etches
authors.forename: Michael C
authors.initials: MC
authors.lastname: Klein
authors.forename: Birgit
authors.initials: B
authors.lastname: Reime
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003696:Delivery Rooms / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D008880:Midwifery / Q000706:statistics & numerical data*; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*