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Primary maternity care outcomes in New Zealand: a comparison of midwife and medical practitioner care

Abstract:

Objectives: To compare the outcomes of primary maternity care delivered by two types of provider: independent midwife and general practitioner. Design: A retrospective cohort study. A regression analysis of two groups of providers on eight indicators of obstetric intervention and adverse outcome using routinely collected data. Setting and participants: Wellington, New Zealand. Primary maternity practitioners and women giving birth between 1 January 1993 and 31 December 1997. Measurements and findings: The eight indicators used were induction, epidural analgesia, instrumental birth, caesarean section, postpartum blood loss, low apgar at 5 minutes, admissions to neonatal intensive care unit, and stillborn. Logistic regression was used to estimate the odds ratios of outcomes, controlling for risk. The study showed that rates of maternal interventions tend to be lower or the same for midwife-led maternity care compared with general practitioner-led care. Conclusions and implications for practice: This study supports midwife-led care as a valid choice for women.

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adverse outcome, maternal interventions, midwife-led care, primary care outcomes