PROCESSES OF CARE: Comparisons of Certified Nurse-Midwives and Obstetricians

Authors

  • Deborah Oakley PhD,

    Corresponding author
      Deborah Oakley, PhD, Center for Nursing Research. School of Nursing, University of Michigan. Ann Arbor, Ml 48109–0482.
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    • Deborah Oakley is professor of nursing and principal investigator of the 5-year National Institute of Nursing Research study (R01-NR01887) titled “Nurse-Midwives and Physicians: A Study of Comparisons.”

  • Terri Murtland CNM, MSN,

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    • Terri Murtfand is a certified nurse-midwife, adjunct lecturer in nursing, and co-principal investigator of the study.

  • Fran Mayes MS, MTS,

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    • Fran Mayes is lecturer in nursing and co-investigator on the study.

  • Robert Hayashi MD,

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    • Robert Hayashi is J. Robert Willson Collegiate Professor of Obstetrics, Director of Maternal-Fetal Medicine, and co-principal investigator of the study.

  • Barbara A. Petersen EDD, CNM,

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    • Barbara Petersen was assistant professor and Director of the nurse-midwife training program in the School of Nursing. She is now Director of the nurse-midwifery program at Vanderbilt University.

  • Cheryl Rorie RN, MS,

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    • Cheryl Rorie is a graduate student in the doctoral program, specializing in maternity.

  • Frank Andersen MD

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    • Frank Andersen was assistant professor of obstetrics and gynecology and a co-principal investigator of the study. He is now Chairman of the Department of Obstetrics and Gynecology, Loma Linda University.


  • At the time of this study, all authors were at the University of Michigan.

Deborah Oakley, PhD, Center for Nursing Research. School of Nursing, University of Michigan. Ann Arbor, Ml 48109–0482.

ABSTRACT

Prenatal and intrapartum care provided to 1,181 women, all meeting risk requirements for nurse-midwifery care, by certified nurse-midwives (n = 471) and obstetricians (n = 710) are compared using indicators of physical and of educational/psychosocial components of maternity care. Data are from clinical records and questionnaires completed by the women. Bivariate analyses show that the two provider groups differ on some, but not all, processes of care. When the woman's evolving health status, personal characteristics, and preferences are controlled, there are significant differences that confirm two models of care. The nurse-midwifery approach emphasizes educational/ psychosocial care and restrained, individualized use of technology. The obstetrics approach emphasizes more routine use of state-of-the-art technology. This study contributes new information to substantiate different models but also shows that both provider groups use elements of both. The difference in emphasis should encourage collaborative practice, given the shared basis for maternity care, whether it is provided by certified nurse-midwives or obstetricians.

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