Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia

  1. Patricia A. Janssen PhD*,
  2. Elizabeth M. Ryan RM, BScN,
  3. Duncan J. Etches MD, CCFP, FCFP,
  4. Michael C. Klein MD, CCFP, FCFP, FCPS,
  5. Birgit Reime DScMPH

Article first published online: 29 MAY 2007

DOI: 10.1111/j.1523-536X.2007.00160.x

Issue

Birth

Birth

Volume 34, Issue 2, pages 140–147, June 2007

Additional Information

How to Cite

Janssen, P. A., Ryan, E. M., Etches, D. J., Klein, M. C. and Reime, B. (2007), Outcomes of Planned Hospital Birth Attended by Midwives Compared with Physicians in British Columbia. Birth, 34: 140–147. doi: 10.1111/j.1523-536X.2007.00160.x

Author Information

  1. 1Patricia A. Janssen is an Associate Professor and Birgit Reime is a Visiting Scholar in the Department of Health Care and Epidemiology, 2Duncan J. Etches is a Clinical Professor and Michael C. Klein is a Professor Emeritus in the Department of Family Practice, and 3Elizabeth M. Ryan is a Clinical Assistant Professor in the Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.

*Patricia A. Janssen, PhD, Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T-1Z3.

Publication History

  1. Issue published online: 29 MAY 2007
  2. Article first published online: 29 MAY 2007
  3. Accepted November 21, 2006

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Keywords:

  • birth;
  • hospital;
  • midwifery;
  • morbidity;
  • obstetrics;
  • pregnancy outcomes

ABSTRACT: Background: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada. Methods: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n =488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n =572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data. Results: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39–0.86), narcotic analgesia (OR 0.26, 95% CI 0.18–0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16–0.30), amniotomy (OR 0.74, 95% CI 0.56–0.98), and episiotomy (OR 0.62, 95% CI 0.42–0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04–0.83) in the midwifery group. Conclusions: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity. (BIRTH 34:2 June 2007)

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