A Comparison Of Visits And Practices Of Nurse-Midwives And Obstetrician-Gynecologists In Ambulatory Care Settings

Authors

  • Lisa L. Paine CNM, DrPH, FACNM,

    Corresponding author
      Lisa Paine, CNM, DrPH, FACNM, Professor and Chair, Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, T5W, Boston, MA 02118-2526.
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    • Lisa Paine, Professor and Chair of the Department of Maternal and Child Health at the Boston University School of Public Health, Boston, MA, served as chair of the ACNM Division of Research, and as project director for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the United States (U.S.). Dr. Paine is also a trustee of the A.C.N.M. Foundation, and an editorial consultant for the Journal of Midwifery and Women's Health.

  • Timothy R. B. Johnson MD, FACOG,

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    • Timothy Johnson, Chair and Bates Professor of the Diseases of Women and Children, Department of Obstetrics and Gynecology at the University of Michigan School of Medicine, Ann Arbor, MI, served as consultant for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S. He is also a trustee of the A.C.N.M. Foundation.

  • Janet M. Lang PhD, ScD,

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    • Janet Lang, Associate Professor of Epidemiology at the Boston University School of Public Health, Boston, MA, served as epidemiology consultant for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S. Dr. Lang is also associate editor of Epidemiology, and the author of numerous papers on perinatal outcomes and epidemiologic methods.

  • David Gagnon MD, MPH,

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    • David Gagnon, Assistant Professor of Biostatistics at the Boston University School of Hygiene and Public Health, Boston, MA, served as biostatistics and analysis consultant for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S.

  • Eugene R. Declercq MBA, PhD,

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    • Eugene Declercq, Associate Professor and Associate Chair of the Department of Maternal and Child Health at the Boston University School of Public Health, Boston, MA, served as consultant for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S. He is also an editorial consultant for the Journal of Midwifery and Women's Health.

  • Jeanne DeJoseph CNM, PhD,

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    • Jeanne DeJoseph, Associate Professor (retired), University of California at San Francisco, School of Nursing, served as a member of the Governing Board of the ACNM Division of Research, and as co-investigator of the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S.

  • Anne Scupholme CNM, MPH, FACNM,

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    • Anne Scupholme, Associate Professor, Department of Obstetrics and Gynecology, University of Miami, and Director of Patient Care Services for Women's Hospital Center, Jackson Memorial Hospital, Miami, FL, served as vice chair of the ACNM Division of Research and as project manager of the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S.

  • Donna Strobino PhD,

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    • Donna Strobino, Professor of Population and Family Health Sciences at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, served as co-investigator of the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S.

  • Alan Ross PhD

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    • Alan Ross, Professor of Biostatistics at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, served as biostatistics and sampling consultant for the study entitled: Nurse-Midwifery Care for Vulnerable Populations in the U.S.


Lisa Paine, CNM, DrPH, FACNM, Professor and Chair, Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, T5W, Boston, MA 02118-2526.

ABSTRACT

With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to women's health care in the United States. The objective of this study was to describe ambulatory visits and practices of CNMs, and compare them with those of obstetrician-gynecologists (OB/GYNs). Sources of population-based data used to compare characteristics of provider visits were three national surveys of CNMs and two National Ambulatory Medical Care Surveys of physicians. When a subset of 4,305 visits to CNMs in 1991 and 1992 were compared to 5,473 visits to OB/GYNs in similar office-based ambulatory care settings in 1989 and 1990, it was found that a larger proportion of CNM visits were made by women who were publicly insured and below age 25. The majority of visits to CNMs were for maternity care; the majority of visits to OB/GYNs were for gynecologic and/or family planning concerns. Face-to-face visit time was longer for CNMs, and involved more client education or counseling. This population-based comparison suggests that CNMs and OB/GYNs provide ambulatory care for women with diverse demographic characteristics and differing clinical service needs. Enhancing collaborative practice could improve health care access for women, which would be especially beneficial for those who are underserved and vulnerable.

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