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Comparative Study
. 2024 Apr 1;7(4):e248676.
doi: 10.1001/jamanetworkopen.2024.8676.

Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care

Carla Sorbara  1 , Joel G Ray  2   3   4 , Elizabeth K Darling  2   5 , Hannah Chung  2 , Sho Podolsky  2 , Therese A Stukel  2   4
Affiliations
Comparative Study

Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care

Carla Sorbara et al. JAMA Netw Open. .

Abstract

Importance: Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.

Objective: To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.

Design, setting, and participants: This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.

Exposures: Perinatal care clinician, namely, a midwife or obstetrician.

Main outcome and measures: : Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.

Results: Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).

Conclusions and relevance: In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Flow Diagram
ED indicates emergency department.
See this image and copyright information in PMC

References

    1. Provincial Council for Maternal Child Health . Standards of Postnatal Care for Mothers and Newborns in Ontario: Birth to one-week postnatal period. 2018. Accessed April 11, 2023 https://www.pcmch.on.ca/wp-content/uploads/2022/05/Standards-of-Postnata...
    1. Clark SL, Belfort MA, Dildy GA, et al. . Emergency department use during the postpartum period: implications for current management of the puerperium. Am J Obstet Gynecol. 2010;203(1):38.e1-38.e6. doi:10.1016/j.ajog.2010.02.033 - DOI - PubMed
    1. Kilfoyle KA, Vrees R, Raker CA, Matteson KA. Nonurgent and urgent emergency department use during pregnancy: an observational study. Am J Obstet Gynecol. 2017;216(2):181.e1-181.e7. doi:10.1016/j.ajog.2016.10.013 - DOI - PMC - PubMed
    1. Malik S, Kothari C, MacCallum C, Liepman M, Tareen S, Rhodes KV. Emergency department use in the perinatal period: an opportunity for early intervention. Ann Emerg Med. 2017;70(6):835-839. doi:10.1016/j.annemergmed.2017.06.020 - DOI - PubMed
    1. Brousseau EC, Danilack V, Cai F, Matteson KA. Emergency department visits for postpartum complications. J Womens Health (Larchmt). 2018;27(3):253-257. doi:10.1089/jwh.2016.6309 - DOI - PMC - PubMed

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