title: Maternity Outcomes in Manitoba Women: A Comparison between Midwifery-led Care and Physician-led Care at Birth.
abstract: Registered midwives, obstetricians/gynecologists, and general or family practice physicians (GPs) provide maternity care across Canada. Few North American studies have assessed whether maternity outcomes differ across these three groups. This study compared maternal and neonatal outcomes of low-risk pregnant women whose birth was attended by registered midwives, obstetricians/gynecologists, and family practice physicians in Winnipeg, Manitoba from 2001/02 to 2012/13.
  
  
  
  Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates.
  
  
  
  Low-risk births comprised 83,774 (48.7%) of total births (n = 171,910). The adjusted odds ratio (aOR), (95% confidence interval) for midwife vs OB/GYN showed women who had a midwife attend the birth had reduced odds of having an episiotomy 0.47 (0.40-0.54), epidural 0.25 (0.23-0.27), and cesarean delivery 0.13 (0.10-0.16) and their infants had less Neonatal Intensive Care Unit admissions 0.28 (0.18-0.43). The aOR for GP versus OB/GYN showed women who had a GP had reduced odds of having an epidural/spinal 0.83 (0.79-0.88) and cesarean delivery 0.44 (0.40-0.48).
  
  
  
  The effectiveness of Manitoba maternity services can be improved with increased use of integrated midwifery services. Future research should examine how midwifery and physician-led models of care differ, and the influence of these differences on birth outcomes and cost-effectiveness to the health care system. Improvement of data tracking systems is also needed.
authors.affiliation: College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kellie
authors.initials: K
authors.lastname: Thiessen
authors.affiliation: Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Nickel
authors.affiliation: Manitoba Centre for Health Policy, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Prior
authors.affiliation: WorkSafeNB, Saint John, NB, Canada.
authors.forename: Ankona
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences GFT, University of Manitoba, Winnipeg, Canada.|Women's Health Program, WRHA, Notre Dame Avenue, Winnipeg, Canada.|Department of Obstetrics Gynecology, Reproductive Sciences University of Manitoba, Notre Dame Avenue, Winnipeg, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Morris
authors.affiliation: Winnipeg Regional Health Authority, Tache Avenue, Winnipeg, MB, Canada.
authors.forename: Kristine
authors.initials: K
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D016015:Logistic Models; D008350:Manitoba; D008427:Maternal Health Services; D009721:Nurse Midwives; D009774:Obstetrics; D010821:Physicians, Family; D011247:Pregnancy; D000078329:Workforce; D055815:Young Adult
keywords: general or family practice physician; midwife; obstetrician/gynecologist