title: Midwifery care and patient-provider communication in maternity decisions in the United States.
abstract: To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient-provider communication in the U.S.
  
  
  BACKGROUND
  Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 to a single newborn in a U.S. hospital (n = 2,400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women's reports about communication. Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR = 2.65, 95 % CI 1.70, 4.14 and AOR = 1.63, 95 % CI 1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider's recommendation (AOR = 0.46, 95 % CI 0.23, 0.89) or because she did not want to be perceived as difficult (AOR = 0.48, 95 % CI 0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR = 0.58, 95 % CI 0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR = 0.54, 95 % CI 0.34, 0.89). Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient-provider communication in maternity care.
authors: Division of Health Policy and Management, University of Minnesota School of Public Health, 720 Delaware St. SE, MMC 729, Minneapolis, MN, 55455, USA, kbk@umn.edu.
authors: Katy B
authors: KB
authors: Kozhimannil
authors: Laura B
authors: LB
authors: Attanasio
authors: Y Tony
authors: YT
authors: Yang
authors: Melissa D
authors: MD
authors: Avery
authors: Eugene
authors: E
authors: Declercq
mesh_terms: D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008880:Midwifery; D009721:Nurse Midwives; D010358:Patient Participation; D018802:Patient-Centered Care / Q000458:organization & administration*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011369:Professional-Patient Relations; D012189:Retrospective Studies; D014481:United States