Journal article
Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery
Annals of family medicine, Vol.22(5), pp.375-382
09/01/2024
DOI: 10.1370/afm.3157
PMCID: PMC11419729
PMID: 39313350
Abstract
PURPOSE Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units.
METHODS Using a cross-sectional design, we surveyed Iowa physicians, nurses, and midwives delivering intrapartum care at hospitals participating in a quality improvement initiative to decrease the incidence of cesarean delivery. We linked respondents with their hospital characteristics and outcomes data. The primary outcome was the association between FM physician, obstetrician (OB), or both disciplines’ presence on labor and delivery and hospital low-risk, primary cesarean delivery rate. Unit culture was compared by hospital type (FM-only, OB-only, or Both).
RESULTS A total of 849 clinicians from 39 hospitals completed the survey; 13 FM-only, 11 OB-only, and 15 hospitals with both. FM-only hospitals were all rural, with <1,000 annual births. Among hospitals with <1,000 annual births, births at FM-only hospitals had an adjusted 34.3% lower risk of cesarean delivery (adjusted incident rate ratio = 0.66; 95% CI, 0.52-.0.98) compared with hospitals with both. Nurses endorsed unit norms more supportive of vaginal birth and stronger safety culture at FM-only hospitals (P <.05).
CONCLUSIONS Birthing hospitals staffed exclusively by FM physicians were more likely to have lower cesarean rates and stronger nursing-rated safety culture. Both access and quality of care provide strong arguments for reinforcing the pipeline of FM physicians training in intrapartum care.
Details
- Title: Subtitle
- Family Medicine Presence on Labor and Delivery: Effect on Safety Culture and Cesarean Delivery
- Creators
- Emily White VanGompel - University of Illinois ChicagoLavisha Singh - NorthShore University HealthSystemFrancesca Carlock - NorthShore University HealthSystemClaire Rittenhouse - University of Illinois ChicagoKelli K. Ryckman - Indiana University BloomingtonStephanie Radke - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Annals of family medicine, Vol.22(5), pp.375-382
- DOI
- 10.1370/afm.3157
- PMID
- 39313350
- PMCID
- PMC11419729
- NLM abbreviation
- Ann Fam Med
- ISSN
- 1544-1709
- eISSN
- 1544-1717
- Publisher
- American Academy of Family Physicians
- Number of pages
- 8
- Grant note
- Agency for Healthcare Research and Quality: K08HS028028 Maternal Health Innovation - Health Resources and Services Administration: U7AMC33719
This work was supported by the Agency for Healthcare Research and Quality (grant No. K08HS028028) and the NorthShore Auxiliary. The Iowa Maternal Quality Care Collaborative (IMQCC) is supported by a Maternal Health Innovation award from the Health Resources and Services Administration (No. U7AMC33719) .
- Language
- English
- Date published
- 09/01/2024
- Academic Unit
- Epidemiology; Obstetrics and Gynecology
- Record Identifier
- 9984719237002771
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