Comparison of labor and delivery care provided by certified nurse-midwives and physicians: A systematic review, 1990 to 2008

Meg Johantgen, Lily Fountain, George Zangaro, Robin Newhouse, Julie Stanik-Hutt, Kathleen White

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: Advanced practice nurses (APNs) in the United States could expand access to high-quality health care, particularly for underserved populations. Yet, there has been limited synthesis of the evidence related to their effectiveness as compared with other providers. The study reported here, part of a larger study that examined all four types of APNs, compares the labor and delivery care outcomes of certified nurse-midwives (CNMs) and physicians. Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Proquest (for dissertations), were searched for the years 1990 through 2008. Study Eligibility Criteria: Only those articles where processes or outcomes of care were quantitatively compared between CNMs and physicians were included. For all APNs, 27,993 citations were reviewed. For CNMs, 21 articles representing 18unique studies reported either infant or maternal outcomes. Methods: The systematic review followed established procedures (replicable search of relevant databases, sequential review to identify eligible studies, abstraction by two reviewers, assessment of quality, and grading of evidence). Results: For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians. Limitations: The review addressed only CNMs practicing in the United States and outcomes measured during labor and delivery. The majority of study designs were observational and the models of care ranged from independent to shared, limiting the control for bias. Moreover, all reviewers were nurses. Conclusion: Differences in practice between CNMs and MDs seem to be well documented, particularly in the use of technology. Yet, the findings provide evidence that care by CNMs is safe and effective. CNMs should be better utilized to address the projected health care workforce shortages.

Original languageEnglish (US)
JournalWomen's Health Issues
Volume22
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Fingerprint

Nurse Midwives
midwife
nurse
physician
labor
Physicians
Nurses
Induced Labor
Episiotomy
Health Manpower
infant
Lacerations
Quality of Health Care
Information Storage and Retrieval
Neonatal Intensive Care Units
Low Birth Weight Infant
Vulnerable Populations
Breast Feeding
health care
PubMed

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Maternity and Midwifery
  • Health(social science)

Cite this

Comparison of labor and delivery care provided by certified nurse-midwives and physicians : A systematic review, 1990 to 2008. / Johantgen, Meg; Fountain, Lily; Zangaro, George; Newhouse, Robin; Stanik-Hutt, Julie; White, Kathleen.

In: Women's Health Issues, Vol. 22, No. 1, 01.2012.

Research output: Contribution to journalArticle

Johantgen, Meg ; Fountain, Lily ; Zangaro, George ; Newhouse, Robin ; Stanik-Hutt, Julie ; White, Kathleen. / Comparison of labor and delivery care provided by certified nurse-midwives and physicians : A systematic review, 1990 to 2008. In: Women's Health Issues. 2012 ; Vol. 22, No. 1.
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