Intrapartum Care and Experiences of Women with Midwives Versus Obstetricians in the Listening to Mothers in California Survey

J Midwifery Womens Health. 2020 Jan;65(1):45-55. doi: 10.1111/jmwh.13027. Epub 2019 Aug 26.


Introduction: Many studies based on hospital records or vital statistics have found that childbearing women experience benefits of lower rates of intervention with midwifery care versus obstetric care during labor and birth. Surveys of women's views and experiences can provide a richer analysis when comparing intrapartum care of midwives and obstetricians.

Methods: This study was a secondary analysis of data from the population-based Listening to Mothers in California survey. The sample, which was representative of 2016 California hospital births, was drawn from birth certificate files and oversampled midwife-attended births. Women responded to the survey in English or Spanish on any device or with a telephone interviewer. The present analysis is based on 1421 of the 2539 participants who identified a midwife or obstetrician as their attendant at a vaginal birth. A bivariate analysis of demographic, attitudinal, and intrapartum variables was conducted. A multivariable model included sociodemographic and attitudinal variables as covariates.

Results: Bivariate analyses found significant socioeconomic differences by type of intrapartum care provider, with women in California attended by midwives more likely to be well educated and privately insured than women attended by obstetricians. Women with midwife birth attendants were less likely to report experiencing various intrapartum medical interventions, less likely to experience pressure to have epidural analgesia, and more likely to report that staff encouraged the woman's decision making. Adjusted odds ratios found that women with midwives were less likely to experience medical interventions, including attempted labor induction; labor augmentation; and use of pain medications, epidural analgesia, and intravenous fluids; and less likely to report pressure to have labor induction or epidural analgesia. Women cared for by midwives were more likely to experience any nonpharmacologic pain relief measures and nitrous oxide and to agree that hospital staff encouraged their decision making.

Discussion: Using women's own reports of their care experiences and adjusting for possible differences in women's attitudes and case mix, we found that midwifery care of women who had vaginal births was associated with reduced use of medical interventions and increased women's decisional latitude during labor and birth.

Keywords: California; certified nurse-midwives; intrapartum care; midwifery; midwives; mothers; nurse-midwives; obstetrician; obstetrics; parturition; surveys and questionnaires.

MeSH terms

  • California
  • Cesarean Section / nursing*
  • Cesarean Section / psychology
  • Decision Making
  • Female
  • Humans
  • Labor Stage, Third
  • Midwifery / methods*
  • Mothers / psychology*
  • Nurse-Patient Relations
  • Obstetric Labor Complications / prevention & control*
  • Perinatal Care / methods*
  • Practice Patterns, Nurses' / organization & administration
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Pregnancy Outcome / psychology*