{"id":19623,"date":"2024-04-29T14:56:18","date_gmt":"2024-04-29T18:56:18","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&p=19623"},"modified":"2024-05-06T15:18:13","modified_gmt":"2024-05-06T19:18:13","slug":"postpartum-emergency-department-use","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/postpartum-emergency-department-use\/","title":{"rendered":"Postpartum emergency department use following midwifery-model vs obstetrics-model care"},"content":{"rendered":"

Importance<\/strong> — Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.<\/p>\n

Objective<\/strong> — To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.<\/p>\n

Design, Setting, and Participants<\/strong> — This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.<\/p>\n

Exposures<\/strong> — Perinatal care clinician, namely, a midwife or obstetrician.<\/p>\n

Main Outcome and Measures<\/strong> — Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.<\/p>\n

Results<\/strong> — Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23\u202f124 women (6.7%) with midwifery-model care compared with 6902 of 81\u202f871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).<\/p>\n

Conclusions and Relevance<\/strong> — In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.<\/p>\n","protected":false},"excerpt":{"rendered":"

Importance — Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum. Objective — To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care. Design, Setting, and Participants — This retrospective […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[24,62,26],"migration-helper-qa-sample-set":[],"class_list":["post-19623","journal_article","type-journal_article","status-publish","hentry","topic-acute-and-emergency-services","topic-health-services-research","topic-maternity-and-neonatal-care"],"acf":{"citation":"Sorbara C, Ray JG, Darling EK, Chung H, Podolsky S, Stukel TA. JAMA Netw Open<\/em>. 2024; 7(4):e248676. Epub 2024 Apr 29.","source_url":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.8676","ices_scientist":[1338,1212,1372],"site":[6733],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"\nICES | Postpartum emergency department use following midwifery-model vs obstetrics-model care<\/title>\n<meta name=\"description\" content=\"Importance — Emergency department (ED) use postpartum is a common and often-preventable event. 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