DO WOMEN CHOOSE THEIR OBSTETRIC PROVIDERS BASED ON RISKS AT ENTRY INTO PRENATAL-CARE - A STUDY OF WOMEN IN WASHINGTON-STATE

Objective: To study risk factors in a large population of women over a broad geographic area as they entered obstetric care, and to assess h ow they distributed themselves among the specialties. Methods: Data fr om 1 year were gathered through a retrospective chart review of all wo men initiating care with randomly selected urban and rural obstetricia ns, urban and rural family physicians, and urban certified nurse midwi ves. Results: The majority of women had at least one risk factor at en try into care. When a scoring system was applied to the data, 13.5% of the women were designated ''high risk,'' which is consistent with fin dings of other studies. However, women did not distribute themselves t o provider types according to risk, Higher-risk women were more likely to choose family physicians, especially in rural areas. Much of this difference can be attributed to young maternal age, late entry into ca re, and lack of health insurance or Medicaid sponsorship. Conclusion: These findings suggest that economics and geography are more likely to influence a woman's initial choice of provider than medical and obste tric risk.