Interspecialty differences in the obstetric care of low-risk women

Am J Public Health. 1997 Mar;87(3):344-51. doi: 10.2105/ajph.87.3.344.


Objectives: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients.

Methods: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted.

Results: Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians.

Conclusions: The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Family Practice / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Humans
  • Middle Aged
  • Nurse Midwives / statistics & numerical data*
  • Obstetrics / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pregnancy Outcome
  • Pregnancy*
  • United States
  • Washington