Certified Nurse-Midwives and Obstetricians: The Choice of a Childbirth Care Provider

Abstract

Health care reform has focused attention on cost savings by use of alternative providers. Yet the question remains: Who would choose such providers? This report on the characteristics of 1464 women who chose either a certified nurse-midwife or a physician and were screened to be of comparable low or moderate risk adds to previous literature because the comparisongroup design was carefully controlled and a wider range of characteristics was compared. Comparisons between women in the two provider groups showed a limited number of statistically significant differences in demographic, reproductive health, nutritional, and psychosocial characteristics and in reasons women gave for choosing their provider. A multiple logistic regression showed that those who wanted care from a woman, preferred a certain style of care, were referred by a friend, had had a previous stressful life event, planned to breastfeed, felt they needed the provider's special ability, and were more internally oriented in locus of control were significantly more likely to select the nurse-midwives. Women who valued the medical center affiliation and never considered the other group were significantly more likely to select an obstetrician. These findings suggest that women have complex reasons, beyond medical risk status, for choosing their type of maternity provider. This study supports the potential for nurse-midwives to participate, with physicians, in plans to restrain health care costs.