Historically, American midwives attended the births of a high risk population. Recently, midwives have provided a higher proportion of maternity care in the U. S.; total births attended by midwives have increased from 1.6% in 1979 to 7.5% in 1998. Purpose: To examine risk factors among midwife attended births relative to physician attended births and to determine if these relationships have changed over two decades. Methods: Natality data (singleton births, 1979 and 1998) were used to determine the risk profile of midwife attended births compared to physicians based on demographic factors associated with increased pregnancy risk: race, age, education, and marital status. To examine differences over time, the risk profile of midwife births was compared between 1979 and 1998. Logistic regression was used to examine the changing demographic composition over the two decades. Results: In 1979, compared to physicians, midwives were more likely to attend births to less educated mothers (OR=1.70,95% CI,1.67,1.74) younger mothers (OR=1.41,95% CI,1.39,1.44), and unmarried mothers (OR=1.50,95% CI,1.47,1.54). In 1998, midwives were also more likely to attend births to less educated mothers (OR=1.45,95% CI,1.44,1.47) younger mothers (OR=1.33,95% CI,1.31,1.34), and unmarried mothers (OR=1.29,95% CI,1.28,1.30). Conclusions: Despite the increase in midwife attended births, midwives continue to care for a demographically high risk population. The magnitudes of the relationships between risk factors and provider, however, have diminished over time. The continuation of midwifery care to high proportions of women at risk may reduce disparities in access to maternity services among high risk populations.
Learning Objectives: Identify four maternal demographic risk factors that have been associated with increased risk for poor pregnancy outcome. Describe the public health implications of midwives continuing to care for a demographically high risk population compared to physicians.
Keywords: Risk Assessment, Midwifery
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.