Comparing perinatal outcomes between hospitals with and without midwife birth attendants

It is possible that hospital culture impacts maternal obstetric outcomes. Here, we sought to understand if differences in perinatal outcomes exist between deliveries at hospitals with midwives compared with those without midwives. We conducted a retrospective cohort study of singleton, non-anomalous, term deliveries in California between 2011-2012 to assess differences in obstetric outcomes between hospitals with midwives to hospitals without midwives. We assessed the presence of midwife birth attendants at each hospital, excluding any birth center or hospital with no MD/DO attendants or < 50 deliveries per year. Chi-square analysis were used to examine differences between presence of midwives and multivariable analysis to control for race/ethnicity, maternal age, education, BMI, insurance status, prenatal care, smoking, and hospital type (size, rural vs. urban, and academic vs. community). Our sample included 106 hospitals with midwife birth attendants and 156 hospitals without birth attendants. 324,245 individuals fit our inclusion criteria, of which 145,598 (44.9%) occurred at hospitals with midwives. After controlling for related individual and hospital factors, deliveries at hospitals with midwives had lower odds of operative vaginal delivery (0.80 [0.70, 0.91]) and cesarean delivery (0.79 [0.72, 0.86]). The rates of operative delivery and cesarean delivery are lower at hospitals with midwives compared to hospitals without midwives, even when adjusting for individual and hospital characteristics. These results indicate that the presence of midwives in hospitals may impact practice of all obstetric providers at the institution. Further work should investigate how inclusion of midwife birth attendants at a hospital changes institutional culture, patient population, and related outcomes.