title: Obstetrician and nurse-midwife collaboration: successful public health and private practice partnership.
abstract: OBJECTIVE
  To evaluate maternal and neonatal outcomes of collaborative maternity care for a socioeconomically diverse patient population in a California community hospital.
  
  
  METHODS
  Collaborative practice structure and clinical guidelines were analyzed, as were de-identified electronic medical records for all primiparous women who delivered term singletons between 2000 and 2010 (N=4,426). Demographics, care processes, and perinatal outcomes were compared among women seen prenatally in a private collaborative practice compared with a Federally Qualified Health Center prenatal clinic run by nurse-midwives.
  
  
  RESULTS
  Evidence-based practices were used to achieve excellent perinatal outcomes. Three quarters of women received intrapartum nurse-midwifery care (74.4%). Few differences were seen in management or outcomes among women from different prenatal clinics despite significant variation in demographic and clinical characteristics. Private practice patients were older, less likely to be obese, and more likely to speak English compared with counterparts from public health clinics. They were also more likely to use hydrotherapy or epidural analgesia, or experience severe perineal laceration and repair. Overall, pharmacologic pain relief methods were limited: less than a quarter of primiparous women used narcotics (21.2%), epidural analgesia (23.7%), or warm water immersion (23.2%). Labor induction and augmentation, and cesarean delivery rates (12.5%), were similar among groups and low overall.
  
  
  CONCLUSIONS
  A collaborative practice of low-tech, high-touch care results in high-quality maternity services. The care model holds promise for replication to address health disparities by limiting obstetric interventions and warrants further investigation with regard to associated costs and resultant outcomes.
  
  
  METHODS
  III.
authors.affiliation: From Sutter West Medical Group, Davis, California.
authors.forename: Jenna
authors.initials: J
authors.lastname: Shaw-Battista
authors.forename: Annette
authors.initials: A
authors.lastname: Fineberg
authors.forename: Barbara
authors.initials: B
authors.lastname: Boehler
authors.forename: Blanche
authors.initials: B
authors.lastname: Skubic
authors.forename: Deborah
authors.initials: D
authors.lastname: Woolley
authors.forename: Zoe
authors.initials: Z
authors.lastname: Tilton
mesh_terms: D000328:Adult; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D005260:Female; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration*; D009721:Nurse Midwives / Q000458:organization & administration*; D009774:Obstetrics / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D019555:Physician-Nurse Relations; D011247:Pregnancy; D011256:Pregnancy Outcome; D011331:Private Practice; D011634:Public Health; D012959:Socioeconomic Factors