title: The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting.
abstract: Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers, and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care.
  
  
  
  Electronic health records for 1,441 medically low-risk women who gave birth at a hospital located in the U.S. Pacific Northwest between January and September 2013 were sampled. Multilevel regression and generalized linear models were used for analysis.
  
  
  
  Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups.
  
  
  
  This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources.
authors.affiliation: University of California, San Francisco, School of Nursing, San Francisco, California. Electronic address: mollyaltman9@gmail.com.
authors.forename: Molly R
authors.initials: MR
authors.lastname: Altman
authors.affiliation: Washington State University, Department of Health Policy and Administration, Spokane, Washington.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
authors.affiliation: Providence Health Care, Spokane, Washington.
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Fitzgerald
authors.affiliation: Providence Regional Medical Center Everett, Everett, Washington.
authors.forename: H Frank
authors.initials: HF
authors.lastname: Andersen
authors.affiliation: Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Kenn B
authors.initials: KB
authors.lastname: Daratha
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D050498:Live Birth / Q000453:epidemiology*; D008427:Maternal Health Services; D008880:Midwifery / Q000191:economics*; D009721:Nurse Midwives; D009774:Obstetrics; D010820:Physicians; D011247:Pregnancy; D011787:Quality of Health Care; D000078329:Workforce; D055815:Young Adult