OBJECTIVE: To evaluate maternal and neonatal outcomes of collaborative maternity care for a socioeconomically diverse patient population in a California community hospital.
METHODS: Collaborative practice structure and clinical guidelines were analyzed, as were de-identified electronic medical records for all primiparous women who delivered term singletons between 2000 and 2010 (N=4,426). Demographics, care processes, and perinatal outcomes were compared among women seen prenatally in a private collaborative practice compared with a Federally Qualified Health Center prenatal clinic run by nurse–midwives.
RESULTS: Evidence-based practices were used to achieve excellent perinatal outcomes. Three quarters of women received intrapartum nurse–midwifery care (74.4%). Few differences were seen in management or outcomes among women from different prenatal clinics despite significant variation in demographic and clinical characteristics. Private practice patients were older, less likely to be obese, and more likely to speak English compared with counterparts from public health clinics. They were also more likely to use hydrotherapy or epidural analgesia, or experience severe perineal laceration and repair. Overall, pharmacologic pain relief methods were limited: less than a quarter of primiparous women used narcotics (21.2%), epidural analgesia (23.7%), or warm water immersion (23.2%). Labor induction and augmentation, and cesarean delivery rates (12.5%), were similar among groups and low overall.
CONCLUSION: A collaborative practice of low-tech, high-touch care results in high-quality maternity services. The care model holds promise for replication to address health disparities by limiting obstetric interventions and warrants further investigation with regard to associated costs and resultant outcomes.
LEVEL OF EVIDENCE: III
Collaboration between obstetricians and nurse–midwives encourages evidence-based maternity care for a diverse population and improves maternal and neonatal outcomes.
From Sutter West Medical Group, Davis, California.
See related editorial on page 503 and related articles on pages 673, 678, and 683.
The authors appreciate the contributions of clinicians at the site of the quality assessment project who provided data, guidance, and editing of this manuscript, including Beth Johnson, MD (Sutter West Medical Group), and Leon Schimmel, MD (CommuniCare Health Centers, Inc.).
Presented at the 2011 annual meeting of the American College of Nurse–Midwives, May 24–28, 2011, San Antonio, Texas.
Corresponding author: Annette Fineberg, MD, Sutter West Medical Group, 2020 Sutter Place, Davis, CA 95616; e-mail: FinebeA@sutterhealth.org.
Financial Disclosure The authors did not report any potential conflicts of interest.