CESAREAN-SECTION RATES IN LOW-RISK PRIVATE PATIENTS MANAGED BY CERTIFIED NURSE-MIDWIVES AND OBSTETRICIANS

This study was designed to assess the impact of selected medical inter ventions during labor upon cesarean section rates by comparing the mat ernal and neonatal outcomes of obstetrician- and nurse-midwife-managed low-risk private patients. All patients who delivered at Prentice Wom en's Hospital in Chicago, Illinois, from January 1, 1987 through Decem ber 31, 1990 were evaluated for low-risk criteria to be included in th e study. During that time, the nurse-midwives delivered 573 patients a nd the obstetricians delivered 12,077 patients. Patients with fetal an d maternal complications known to increase the cesarean section rate w ere eliminated from both groups. Eight percent of the nurse-midwife pa tients and 32% of the physician patients were eliminated, leaving 529 nurse-midwife patients and 8,266 physician patients. These patients we re compared for race, parity, age, and birth weight. Information was c ollected from a perinatal data base and hospital computerized statisti cs. The rates of cesarean section, administration of oxytocin, analges ia, anesthesia, and infant outcome data were compared by chi-square an alysis. Multiple logistic regression analysis was used to assess facto rs that predicted cesarean section. Nurse-midwife-managed patients had a significantly lower rate of cesarean section (8.5% versus 12.9%; P < .005) and operative vaginal delivery (5.3% versus 17%, P = .0001) th an the physician-managed patients. Epidural anesthesia and oxytocin fo r induction and augmentation were used significantly more frequently i n the physician-managed patients. Both interventions were associated w ith an increased rate of cesarean section. Fetal outcomes in the two g roups were not statistically different Women cared for by nurse-midwiv es had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with those cared for by physicians.