4.5 Article

Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes

Journal

CANADIAN MEDICAL ASSOCIATION JOURNAL
Volume 184, Issue 17, Pages 1885-1892

Publisher

CMA-CANADIAN MEDICAL ASSOC
DOI: 10.1503/cmaj.111753

Keywords

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Funding

  1. Canadian Federal Primary Health Care Transition Fund
  2. Provincial Health Services
  3. Vancouver Coastal Health Authorities in British Columbia

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Background: The number of physicians providing maternity care in Canada is decreasing, and the rate of cesarean delivery is increasing. We evaluated the effect on perinatal outcomes of an interdisciplinary program de signed to promote physiologic birth and encourage active involvement of women and their families in maternity care. Methods: We conducted a retrospective cohort study involving 1238 women who attended the South Community Birth Program in Vancouver, Canada, from April 2004 to October 2010. The program offers comprehensive, collaborative, interdisciplinary care from family physicians, midwives, community health nurses and doulas to a multi-ethnic, low-income population. A comparison group, matched for neighbourhood of residence, maternal age, parity and gestational age at delivery, comprised 1238 women receiving standard care in community-based family physician, obstetrician and midwife practices. The primary outcome was the proportion of women who underwent cesarean delivery. Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean +/- standard deviation 50.6 +/- 47.1 v. 72.7 +/- 66.7 h, p < 0.001) and the newborns (47.5 +/- 92.6 v. 70.6 +/- 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breast feeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39). Interpretation: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

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