A comparison of labor and delivery management between nurse midwives and family physicians

Practice associations between family physicians and nurse midwives have been suggested as a means to increase the availability of obstetric care in rural areas. No evidence exists, however, that family physicians and midwives have comparable practice styles or achieve similar outcomes in obstetric patients.

The study examines patients cared for by a co-practice of nurse midwives and family physicians at a rural hospital. Data were collected through a retrospective chart audit for all patients whose prenatal care, labor, or delivery was managed by members of the practice in 1990 and 1991.

Few differences were noted between nurse midwives and family physicians in the management of labor or delivery. The only consistent finding was that family physicians were more likely than midwives to use an episiotomy for delivery (40% vs 30% in primiparous women, P = .02; and 20% vs 10% in multiparous women, P = .007). Despite seemingly similar management styles, primiparous women managed by family physicians were more likely to undergo cesarean section (14% vs 8%, P = .05) resulting from the diagnosis of dystocia. When practice specialty was included in a logistic regression model with parity and the number of preexisting risk factors, the effect of specialty on cesarean sections remained significant with a relative risk of 2.79 for cesarean section if patients had their labor managed by a family physician (P < .001).

Family physicians and nurse midwives managed patients in labor similarly, but nurse midwives were more likely to achieve a vaginal delivery in primiparous women and do so without an episiotomy. Although the differences found would not interfere with a collaborative practice, subtle differences in patient management do exist. Further exploration of these differences may be helpful in understanding the impact of these differences on mixed-specialty practices.