Preventing Cesarean Birth in Women with Obesity: Influence of Unit-Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set.

This was a retrospective secondary analysis, so it shows association, not that midwifery presence caused lower cesarean rates. The dataset could not reliably trace each woman's intrapartum care to a midwife or physician, so comparisons were only at the unit level. All centers were teaching, tertiary care centers with 24-hour obstetric, maternal-fetal, anesthesia, and neonatology coverage and Level II or III neonatal intensive care units, so results may not apply to smaller or rural hospitals. The sample was limited to healthy, low-risk term singleton cephalic labors and excluded many pre-existing conditions, so findings do not cover higher-risk pregnancies. The data were collected before national efforts to reduce primary cesarean birth by reconsidering active phase cervical dilation. Only the first documented birth per woman was included, and cases missing age, race, or health insurance were excluded.

The authors declared no conflicts of interest. The supplied text does not report a funding source.

Do not conclude that adding midwives to a labor unit causes fewer cesareans, especially for women with obesity. This was a retrospective cohort study that could not track individual provider care, and the lower adjusted odds did not persist for women with BMI higher than 35 kg/m2.