Collaboration Between Midwife and Laborist Can Improve Birth Outcomes

To address rising rates of cesarean delivery, the use of laborists (generally defined as obstetricians who exclusively cover inpatient labor and delivery) has grown. In a prospective cohort study, researchers at one community hospital assessed a collaborative model between in-hospital midwives and laborists and its effect on rates of cesarean delivery and vaginal birth after cesarean (VBAC) in 4884 births. Outcomes in a cohort of privately insured patients were compared before and after introduction of the laborist model.

Among the privately insured nulliparous women, primary cesarean rates dropped from 32% before introduction of the midwife–laborist model to 25% afterwards (adjusted odds ratio, 0.56; P=0.002), and VBAC rates rose from 13% t…