Objective
To examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital.
Methods
This was a retrospective cohort study of 9,381 singleton live births at one community hospital, where women were provided labor and delivery care under one of two distinct practice models: a traditional “private” practice model and a midwife-physician “laborist” practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the chi square test and multivariable logistical regression.
Results
Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%, p<0.001; adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.73-2.58). Women with nulliparous, term, singleton, vertex (NTSV) gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% versus 15.9%, p<0.001; aOR 1.86, 95% CI 1.33-2.58) as were women who had a prior cesarean delivery (71.3% versus 41.4%, p<0.001; aOR 3.19, 95% CI 1.74-5.88).
Conclusion
In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.