title: Recent trends in clinicians providing care to pregnant women in the United States.
abstract: BACKGROUND
  Health care needs of pregnant women are met by a variety of clinicians in a changing policy and practice environment. This study documents recent trends in types of clinicians providing care to pregnant women in the United States.
  
  
  METHODS
  We used a repeat cross-sectional design and data from the Integrated Health Interview Series (2000-2009), a nationally representative data set, for respondents who reported being pregnant at the time of the survey (N = 3204). Using longitudinal logistic regression models, we analyzed changes over time in pregnant women's reported use of care from 1) obstetrician-gynecologists; 2) midwives, nurse practitioners (NPs), or physician assistants (PAs); or 3) both an obstetrician-gynecologist and a midwife, NP, or PA.
  
  
  RESULTS
  The percentage of pregnant women who reported seeing an obstetrician-gynecologist (87%) remained steady from 2000 through 2009. After controlling for demographic and clinical variables, the percentage who reported receiving care from a midwife, NP, or PA increased 4% annually (yearly adjusted odds ratio [AOR] 1.04; P < .001), indicating a cumulative increase of 48% over the decade. The percentage of pregnant women who received care from both an obstetrician-gynecologist and a midwife, NP, or PA also increased (AOR 1.027; P < .001), for a cumulative increase of 30%.
  
  
  CONCLUSIONS
  The increasing role of midwives, NPs, and PAs in the provision of maternity care suggests changes in the perinatal workforce and practice models that may promote collaborative care and quality improvement. However, better data collection is required to gather detailed information on specific provider types, these trends, and their implications.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of PublicHealth, Minneapolis, MN55455, USA. kbk@umn.edu
authors.forename: Katy Backes
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Avery
authors.forename: Carrie Ann
authors.initials: CA
authors.lastname: Terrell
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008427:Maternal Health Services / Q000706:statistics & numerical data / Q000639:trends*; D016389:Maternal-Child Nursing / Q000706:statistics & numerical data / Q000639:trends*; D008880:Midwifery / Q000706:statistics & numerical data / Q000639:trends; D024802:Nurse's Role; D009774:Obstetrics / Q000706:statistics & numerical data / Q000639:trends; D010823:Physician Assistants / Q000706:statistics & numerical data / Q000639:trends; D011247:Pregnancy; D011295:Prenatal Care / Q000639:trends*; D011369:Professional-Patient Relations; D014481:United States; D016387:Women's Health