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- Title
Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care.
- Authors
Sorbara, Carla; Ray, Joel G.; Darling, Elizabeth K.; Chung, Hannah; Podolsky, Sho; Stukel, Therese A.
- Abstract
Key Points: Question: Is care by a midwife compared with an obstetrician associated with different rates of emergency department (ED) use in the postpartum period? Findings: In this cohort study of 104 995 patients who were low risk, women receiving innovative midwifery-model care experienced a 22% lower risk of ED use post partum than patients receiving traditional obstetrics-model care. Meaning: These findings suggest that midwifery-model care, which offers early postpartum visits, may reduce maternal ED use after birth; this approach may fill an important gap in postpartum care. This cohort study examines whether postpartum emergency department use differs among women who received perinatal care in a midwifery model vs in a traditional obstetrics model among women in Ontario, Canada. Importance: Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum. Objective: To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care. Design, Setting, and Participants: This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023. Exposures: Perinatal care clinician, namely, a midwife or obstetrician. Main Outcome and Measures: : Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights. Results: Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77). Conclusions and Relevance: In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.
- Subjects
ONTARIO; MEDICAL care use; CESAREAN section; RISK assessment; POISSON distribution; STATISTICAL models; EMIGRATION &; immigration; SUBSTANCE abuse; MATERNAL health services; RESEARCH funding; DELIVERY (Obstetrics); VAGINA; LOGISTIC regression analysis; PATIENT readmissions; RESIDENTIAL patterns; SMOKING; POSTNATAL care; HOSPITAL emergency services; RETROSPECTIVE studies; DESCRIPTIVE statistics; RELATIVE medical risk; AGE distribution; LONGITUDINAL method; HUMAN reproductive technology; ENGLISH as a foreign language; EPISIOTOMY; MIDWIFERY; CONFIDENCE intervals; DATA analysis software; ALCOHOLISM; COMPARATIVE studies; OBESITY
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe248676
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8676