Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization

J Midwifery Womens Health. 2018 Jan;63(1):14-22. doi: 10.1111/jmwh.12702. Epub 2017 Nov 16.


Introduction: Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and obstetric procedure utilization.

Methods: This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014. Using logistic regression, we estimated the association between the hospital-level percentage of midwife-attended births and 4 outcomes among low-risk women: labor induction, cesarean birth, episiotomy, and severe maternal morbidity.

Results: Hospital-level percentage of midwife-attended births was not associated with reduced odds of labor induction or severe maternal morbidity. Women who gave births at hospitals with more midwife-attended births had lower odds of giving birth by cesarean (eg, adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.59-0.82 at a hospital with 15% to 40% of births attended by midwives, compared to no midwife-attended births) and lower odds of episiotomy (eg, aOR, 0.41; 95% CI, 0.23-0.74 at a hospital with more than 40% of births attended by midwives, compared to no midwife-attended births).

Discussion: Our results indicate that hospitals with more midwife-attended births have lower utilization of some obstetric procedures among low-risk women; this raises the possibility of improving value in maternity care through greater access to midwifery care.

Keywords: cesarean birth; health care quality; maternity care; midwifery care; obstetric procedure utilization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cesarean Section
  • Databases, Factual
  • Delivery, Obstetric* / nursing
  • Episiotomy
  • Female
  • Hospitals*
  • Humans
  • Labor, Induced
  • Logistic Models
  • Maternal Health*
  • Midwifery*
  • New York
  • Nurse Midwives*
  • Obstetrics
  • Odds Ratio
  • Parturition
  • Perinatal Care*
  • Pregnancy
  • Procedures and Techniques Utilization*
  • Young Adult