title: Two practice models in one labor and delivery unit: association with cesarean delivery rates.
abstract: OBJECTIVE
  The objective of the study was to examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital.
  This was a retrospective cohort study of 9381 singleton live births at 1 community hospital, at which women were provided labor and delivery care under 1 of 2 distinct practice models: a traditional private practice model and a midwife-physician laborist practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the χ(2) test and multivariable logistical regression.
  
  
  RESULTS
  Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%; P < .001; adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.73-2.58). Women with nulliparous, term, singleton, vertex gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% vs 15.9%; P < .001; aOR, 1.86; 95% CI, 1.33-2.58) as were women who had a prior cesarean delivery (71.3% vs 41.4%; P < .001; aOR, 3.19; 95% CI, 1.74-5.88).
  
  
  CONCLUSIONS
  In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.
authors.affiliation: Prima Medical Foundation, Novato, CA and Department of Obstetrics and Gynecology, Marin General Hospital, Greenbrae, CA.
authors.forename: Malini Anand
authors.initials: MA
authors.lastname: Nijagal
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA. Electronic address: kuppermannm@obgyn.ucsf.edu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, CA; Department of Obstetrics and Gynecology, University of California, Davis, School of Medicine, Davis, CA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D000328:Adult; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008880:Midwifery; D009774:Obstetrics; D011247:Pregnancy; D011331:Private Practice; D012189:Retrospective Studies
keywords: cesarean delivery; labor and delivery practice; midwife-physician laborist practice; private practice