Perinatal Outcomes by Provider Type in a Universally Insured Population
The purpose of the study was to examine perinatal outcomes between CNMs and physicians in a nationally-representative, universally-insured health system in which CNMs have full practice authority.
Using the Military Health Data Repository (MDR), our retrospective study looked at Tricare Prime and Plus beneficiaries from ages 16 to 50 who gave birth during fiscal years 2012 to 2014. This study was attainable through a data sharing agreement between Comparative Effectiveness and Provider Induced Demand Collaboration (EPIC) and the DoD and is considered exempt under the Uniformed Services University of the Health Sciences Institutional Review Board. Our data was drawn from a 9.5 million population in MDR, which houses a vast population of women during their prime age of maternity.
We looked at antepartum outcomes (care by number of antepartum visits: 4-6 visits or 7 or more visits); intrapartum outcomes (vaginal births, cesarean sections, vaginal births after cesarean section (VBAC), episiotomy rates, inductions/augmentations, complications, endometritis, administration of antenatal steroids); postpartum outcomes (postpartum hemorrhage) and newborn outcomes (breastfeeding rates, newborn complications, low birth weight, very low birth weight, preterm). We were able to extract deliveries and the majority of the perinatal care variables using ICD-9 and CPT codes.
"These results have significant implications for the composition of our nation’s women’s health workforce."
In states with autonomous women with births attended by CNMs in states with autonomous CNM practice had less odds of cesarean delivery, preterm birth, and low birth weight babies.
CNMs attended 30.8% of births in Military Treatment Facilities. Women with births attended by CNMs had greater odds of a vaginal birth, vaginal birth after cesarean section, and breastfeeding, along with lower odds of induction/augmentation of labor, endometritis, and preterm birth.
In a system of universal insurance where CNMs work to their fullest scope of authority, there are a greater proportion of CNM-attended births. CNMs are experts at managing low-risk women for prenatal care and births, with positive materna/infant outcomes.
This research was funded by a grant from the United States Defense Health Agency, through the Henry M. Jackson Foundation for the Advancement of Military Medicine, for the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC): A Study of Variation in Healthcare.