Linking obstetric and midwifery practice with optimal outcomes.

OBJECTIVE To compare midwifery and medical care practices and measure optimal perinatal outcomes using a new clinimetric instrument. DESIGN Prospective descriptive cohort design. SETTING A large, inner city obstetric service with medical and midwifery services. PARTICIPANTS Three hundred seventy-five of 400 consecutively enrolled patients were participated (25 excluded due to extreme risk status or missing data); 92% were of minority race/ethnicity and 54% had less than a high school education. Of the 375 patients, 179 received physician care and 196 received nurse-midwife care. MAIN OUTCOME MEASURES The Optimality Index-US was measured. Health record data were extracted and scored using the Optimality Index-US to summarize the optimality of processes and outcomes of care as well as the woman's preexisting health status. RESULTS Midwifery patients had more optimal care processes (less use of technology and intervention) with no difference in neonatal outcomes, even when preexisting risk was taken into account. CONCLUSION Even among moderate-risk patients, the midwifery model of care with its limited use of interventions can produce outcomes equivalent to or better than those of the biomedical model.