Toward Lower Cesarean Birth Rates and Effective Care: Five Years' Outcomes of Joint Private Obstetric Practice

Abstract

An obstetric practice in a private community hospital setting that effectively used obstetricians, nurse-midwives, and nurse practitioners reported low rates of cesarean birth, preterm birth, severe lacerations, instrument deliveries, and legal incidents, and excellent cost-effective maternal and neonatal outcomes.

Obstetrician and Nurse–Midwife Collaboration

“…31 Further, data from the practice suggest that optimal maternity care is fostered within the collaborative model and cannot be exclusively attributed to the demographics or clinical characteristics of the patient population. [1][2][3][4]32,33 Therefore, patients' belief systems may not be a barrier to collaborative practice elsewhere, using the model of care described.…”

“…12 As demonstrated in this project and previous studies at the hospital, outcomes of the collaborative practice in Davis, California, meet or exceed measures of excellence, despite an economically and socially diverse population with significant risk factors for operative delivery, poor perinatal outcomes, and health disparities. [1][2][3][4][5][6] The primary objective of this study was to assess whether maternity care practices and perinatal outcomes differed among women attended prenatally in federally qualified health centers compared with the collaborative private practice. Prenatal care site was examined as a proxy for socioeconomic and insurance status considering that the majority of women in the private practice have employee-sponsored or personal health insurance policies (more than 85%), whereas the federally qualified health center serves exclusively uninsured and low-income women enrolled in government health insurance programs.…”

“…Practice members actively participated in efforts to identify key administrative factors and clinical guidelines that have contributed to the longevity and success of the collaboration. [1][2][3][4] This quality assessment project had three additional goals: 1) articulate a shared philosophy of collaborative maternity care developed through an iterative process undertaken by interprofessional group members, 2) re-evaluate the evidence base for intrapartum management as part of ongoing clinical guidelines review, and 3) analyze de-identified electronic medical record data from 2000 to 2010 to assess whether maternity care practices or perinatal outcomes differed among firsttime mothers who were seen prenatally by a nursemidwife in a federally qualified health center compared with those seen by a nurse-midwife or obstetrician or both in the collaborative private practice.…”

“…Interprofessional clinicians believe that high-touch, low-tech care practices resulted in the limited use of pharmacologic pain relief methods and obstetric interventions, and optimal perinatal outcomes observed previously at the site. [1][2][3][4] Further, postpartum patient satisfaction has ranked in the 91st through 95th percentiles over the past decade according to Press-Ganey national surveys. The objective of this quality assessment study was to re-evaluate the model of care and maternity services provided by the collaborative practice, and assess both adherence to stated philosophy and the quality of resultant maternalneonatal outcomes in the socially and economically diverse child bearing population.…”

“…The patient population, collaborative practice, and selected perinatal outcomes have been described previously. [1][2][3][4] Women seen prenatally by members of the collaborative practice give birth at Sutter Davis Hospital, a 45-bed community facility with a level I nursery located in a college town situated between two major metropolitan areas and expansive agricultural areas.The collaborative practice philosophy includes extensive prenatal education, shared decision-mak- …”