Infant emergency department use after midwifery- versus obstetrician-led perinatal care: a population-based cohort study

Objective — To assess whether infant emergency department (ED) use differs between a midwifery-based and obstetrics-based model of care.

Design — Retrospective population-based cohort study.

Setting — Province of Ontario, Canada.

Population — Infants born to low-risk primiparous women in a hospital, 2012–2021.

Methods — Modified Poisson regression compared ED use between women with midwifery and obstetrics-model care, weighting by propensity-based overlap weights.

Main outcome measures — Any unscheduled infant ED visit after the birth hospitalisation discharge date up to 27 days thereafter.

Results — Included were 36 949 livebirths to women receiving care by a midwife and 120 463 to women receiving care by an obstetrician. Median gestational age at birth was 39 weeks; 11.8% and 13.3% were admitted to the NICU, and the median newborn hospital length of stay was 1.3 and 1.8 days, respectively. Midwifery-care mother–child pairs received a median of 6.9 postpartum visits by a midwife. An infant ED visit ≤ 27 days occurred among 1789 (4.8%) midwife-led care patients versus 11 886 (9.9%) obstetrician-led care recipients (relative risk [RR] 0.51, 95% CI 0.49 to 0.54; absolute risk difference −4.6%, 95% CI −4.9 to −4.3). The corresponding RR was 0.42 (95% CI 0.39 to 0.46) for infant ED visit ≤ 7 days and 0.87 (95% CI 0.86 to 0.89) for infant ED visit ≤ 365 days.

Conclusions — Among infants born to low-risk primiparous women, midwifery-model care was associated with less ED use after birth than an obstetrics model of care. Among similar populations, enhanced access to midwifery care might reduce postnatal newborn resource use.