Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse-Midwife to Obstetrician Intrapartum Care.
Nicole S Carlson, Elizabeth J Corwin, Nancy K Lowe
PMID 28099786WHAT IT FOUND
Care by nurse-midwives was associated with fewer operative vaginal births and severe tears compared to obstetricians.
Cesarean rates were similar. Nurse-midwives used more physiologic interventions and waited longer before starting oxytocin or rupturing membranes.
Key findings
01Nurse-midwife care was associated with significantly lower rates of operative vaginal birth and third- or fourth-degree perineal lacerations compared to obstetrician care.
02Cesarean birth rates did not differ significantly between the two provider groups.
03Nurse-midwives waited significantly longer before initiating oxytocin augmentation, artificial rupture of membranes, or intrauterine pressure catheters, while using more physiologic interventions like ambulation and hydrotherapy.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective, so it cannot prove that provider type caused the differences in outcomes. Women with significant comorbidities like diabetes or hypertension were excluded, limiting the findings to healthier women with obesity. The study took place in a hospital with lower-than-average cesarean rates, so results may not apply to settings with higher intervention rates. Some baseline differences remained between groups despite matching, such as ethnicity and gestational age at labor onset.
Declared interests
The authors report no conflict of interest.
The easy way to misread this
Do not assume that nurse-midwife care reduces cesarean birth rates in women with obesity. The study found no significant difference in cesarean rates between the two provider groups. The benefits observed were primarily in reduced operative vaginal births and severe tears, not in avoiding cesarean sections.