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Midwife annual delivery workload and maternal and neonatal adverse outcomes, is there an association?
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  • Misgav Rottenstreich,
  • Reut Rotem,
  • Pnina Mor,
  • Orna Reichman,
  • Amihai Rottenstreich,
  • Sorina Grisaru-Granovsky,
  • Hen Sela
Misgav Rottenstreich
Shaare Zedek Medical Center
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Reut Rotem
Shaare Zedek Medical Center
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Pnina Mor
Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School
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Orna Reichman
Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School
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Amihai Rottenstreich
Hadassah- Hebrew University Medical Center
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Sorina Grisaru-Granovsky
Shaare Zedek Medical Center
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Hen Sela
Shaare Zedek Medical Center
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Abstract

Objective: To evaluate the association between certified nurse midwife (CNM) annual delivery workload and short-term, adverse maternal and neonatal outcomes occurring in vaginal deliveries. Design: A retrospective cohort study Setting: A single tertiary academic center. Population: All single, live vertex term vaginal deliveries between 2006 and 2018 were included Methods: deliveries were categorized into two groups based on the CNM median annual volume of deliveries during the study duration. The “high-volume” and “low-volume” groups included deliveries above and below the median annual delivery volume, respectively as a dichotomous variable. Further analyses were performed for the annual volume by deciles. Main outcomes measures: Short term maternal and neonatal outcomes were compared between “high-volume” and “low-volume” groups and between deciles. Results: During the study period 140,856 deliveries met the study criteria. The median annual deliveries of a single CNM was 152 [114-195]. Maternal and labor characteristics were comparable between the groups. Maternal outcomes were not significantly associated with the CNM’s annual workload. However, neonates delivered by CNMs with “low” annual volume had higher a higher rate of neonatal jaundice (aOR 1.07, 95% CI [1.00-1.14]) and mechanical ventilation (aOR 1.32, 95% CI [1.05-1.66). Conclusion: Adverse perinatal outcomes are only mildly affected by CNM’s annual volume after controlling for the CNM, parturient and neonate’s characteristics. Funding: This study was not funded by any organization.