COMPARISONS OF OUTCOMES OF MATERNITY CARE BY OBSTETRICIANS AND CERTIFIED NURSE-MIDWIVES

Objective: To determine whether pregnancy outcomes differ by provider group when alternative explanations are taken into account. Methods: P regnancy outcomes were compared for 710 women cared for by private obs tetricians and 471 cared for by certified nurse-midwives. At intake, a ll women qualified for nurse-midwifery care. They were retained in the ir original group for analysis, even if they were later referred to ph ysicians. Infant and maternal mortality, 30 clinical indicators, satis faction with care, and monetary charges were studied. The study site's history and philosophy of honoring consumer choice of provider preclu ded random assignment, but multivariate analyses minimized the effects of multiple confounding factors. The statistical power was adequate f or the study design. Results: Significant differences (P < .05) betwee n the obstetrician and nurse-midwife groups were found for seven clini cally important outcomes: infant abrasions (7 versus 4%), infant remai ning with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complic ations (0.7 versus 0.4), satisfaction with care, average hospital char ges ($5427 versus $4296), and average professional fee charges ($3425 versus $3237). When maternal risk, selection bias, and the medical int ensiveness of care were controlled, the provider group did not continu e to have an independent effect on infant abrasions, hemorrhage, and p rofessional fee charges; when women's preferences were added, the diff erence in hospital charges disappeared. However, the provider group co ntinued to have significant independent effects on the other four outc omes. Interaction effects were not significant.Conclusion: Although mo st outcomes were equally good, important differences between obstetric ian and nurse-midwife care remained after multivariate analysis.