Low ‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors

We examined hospital use of low‐interventional practices, as well as variation in utilization across hospitals.MethodsData came from 185 California hospitals completing a survey of intrapartum care, including 9 questions indicating use of low ‐ versus high‐interventional practices (eg, use of intermittent auscultation, nonpharmacologic pain relief, and admission of women in latent labor). We performed a group‐based latent class analysis to identify distinct groups of hospitals exhibiting different levels of utilization on these 9 m easures. Multivariable logistic regression identified institutional characteristics associated with a hospital's likelihood of using low‐interventional practices. Procedure rates and patient outcomes were compared between the hospital groups using bivariate analysis.ResultsWe identified 2 distinct groups of hospitals that tended to use low ‐interventional (n = 44, 23.8%) and high‐interventional (n = 141, 76.2%) practices, respectively. Hospitals more likely to use low‐interventional practices included those with midwife‐led or physician‐midwife collaborative labor management (adjusted odds ratio [aOR], 7.52; 95% CI, 2.53‐2 2.37;P< .001) and those in rural locations (aOR, 3.73; 95% CI, 1.03 ‐13.60;P = .04). Hospitals with a higher proportion of women covered by Medicaid or other safety ‐net programs were less likely to use low‐interventional practices (aOR, 0.96; 95% CI, 0.93‐0.99;P = .004), as were hospitals in coun...

Source: Journal of Midwifery and Women's Health - September 9, 2019 Category: Midwifery Authors: Lisbet S. Lundsberg, Elliott K. Main, Henry C. Lee, Haiqun Lin, Jessica L. Illuzzi, Xiao Xu Tags: Original Research Source Type: research