Date of Conferral

2021

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Peter B. Anderson

Abstract

In the United States, over the last four decades, medical interventions in labor were intended to be a rare practice, to be used only when the benefits of birth outweighed the risk to the pregnant individual and fetus. This study was conducted to compare obstetricians gynecologists and family medicine physicians (OB/GYNs and FMPs) in an urban academic medical setting and to identify if they were practicing in an evidence-based manner as recommended by their respecting professional bodies by assessing for (a) associations between provider type and intervention (such as induction and augmentation) and for (b) labor and delivery outcomes for low-risk healthy pregnancies. Archival data was obtained from a family medicine quality improvement project at an urban academic medical center. Diffusion of innovation theory was used to identify which provider types were adopters or laggards of the current American College of Obstetrician Gynecologists practice guidelines. The major finding of this study was that augmentation was used significantly more often by OB/GYNs than FMPs. FMPs showed a 22% decreased likelihood of augmentation than OB/GYNs. In addition, there was a 23% increase in the risk of a poor labor and/or poor birth outcome with induction. This study provides a framework for assessing and comparing the use of labor and delivery interventions among provider types and labor and delivery outcomes for healthy low-risk pregnancies and labors. Once the framework is applied, medical institutions should be able to make recommendations about best practices to improve outcomes in maternal health, including labor and birth. The positive social change is the improved overall health of the community.

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