Midwifery Workforce Density Moderates the Association Between Independent Practice and Pregnancy Outcomes

The objective was to test if the local midwife density moderates the association between state independent midwifery practice and pregnancy outcomes.MethodsBirth records were abstracted from the State Inpatient Databases for 6 states. The Area Health Resource File provided county variables. Midwife density was operationalized as no midwives, low midwife density (<4.5 per 1000 births), and high midwife density ( ≥4.5 midwives per 1000 births). Multivariate logistic regression models compared primary cesarean birth and preterm birth, controlling for maternal and county characteristics. Moderation was tested by including an interaction term (independent practice × density) to the regression models. The mag nitude of association for the interaction was measured by stratifying the models.ResultsThe study included 875,156 women; most (79.7%) resided in a county with low midwife density. Restricted midwifery practice was associated with increased odds of both primary cesarean birth and preterm birth. The interaction term was significant for both preterm birth and primary cesarean, indicating moderation. The largest magnitude of difference was the increased odds of preterm birth in counties with a high midwife density and restricted practice (odds ratio, 3.50; 95% CI, 2.43-5.06) compared with those with high midwife density and independent practice.DiscussionMidwife density moderates the association between independent midwifery practice and primary cesarean birth and preterm b...
Source: Journal of Midwifery and Women's Health - Category: Midwifery Authors: Tags: Research Article Source Type: research