Term of Award

Spring 2018

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

Julie Reagan

Committee Member 2

Yelena Tarasenko


Objective: The purpose of this study was to determine if there is variation in interventions and complications in the labors of women cared for by nurse midwives compared with physicians after controlling for medical risks and sociodemographic factors in pregnant women in Georgia, New Mexico, Illinois, Virginia, and Alaska.

Methods: The study was based on a secondary analysis of 2015 Birth Certificate Data from the National Center for Health Statistics. The outcome variables included VBAC, induction/augmentation of labor, third and fourth-degree laceration, and chorioamnionitis. The exposure of interest was provider type- nurse-midwife or physician. Multiple logistic regression was used to determine relationships between the exposure of interest and the outcome variables.

Results: After adjusting for covariates, statistically significant associations were found between provider type and all interventions and complications, with lower odds of chorioamnionitis and higher odds of VBAC, third and fourth-degree laceration and induction/augmentation of labor among midwives than physicians.

Conclusions: There are several important implications concerning provider type and collaborative practices as a potential contributor to improved maternity care in the United States from this study’s findings. Future research is warranted to clarify the nature of collaborations.

Research Data and Supplementary Material