title: Impact of prenatal care provider on the use of ancillary health services during pregnancy.
abstract: BACKGROUND
  Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy.
  
  
  METHODS
  Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women's experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy.
  
  
  RESULTS
  During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician.
  
  
  CONCLUSIONS
  Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience.
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, BC Women’s and Children’s Hospital, 4500 Oak St, Vancouver, BC V6H 3N1, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Metcalfe
authors.forename: Kristen
authors.initials: K
authors.lastname: Grabowska
authors.forename: Carol
authors.initials: C
authors.lastname: Weller
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Tough
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008880:Midwifery / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000706:statistics & numerical data; D009774:Obstetrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires