{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:42:05Z","timestamp":1787236925332,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Studies suggest that midwifery care can decrease the rate of unplanned cesarean birth. In this study, we compared unplanned cesarean rates, labor interventions, and birth outcomes for mixed\u2010risk patients receiving intrapartum care from obstetricians or midwives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included nulliparous and multiparous patients with a term, singleton, vertex fetus. We included induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high\u2010risk diagnosis requiring obstetrician care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our cohort included 7694 patients. Of those, 3543 (46.0%) received intrapartum care from an obstetrician and 4151 (54.0%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% vs. 15.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) overall and by adjusted analysis [aOR 0.49 (0.40\u20130.60) 95% CI]. Patients receiving obstetrician care more frequently experienced induction\/augmentation, neuraxial anesthesia, and operative vaginal delivery. Obstetrician\u2010led care was associated with increased lacerations, intra\u2010amniotic infection, and severe maternal morbidity, while midwifery\u2010led care was associated with increased rates of postpartum hemorrhage, blood transfusion, and shoulder dystocia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Midwifery intrapartum care was associated with lower rates of unplanned cesarean birth in this mixed\u2010risk cohort of laboring and induced patients. Wider integration of midwives for intrapartum care could increase vaginal delivery rates. Additional studies are needed to explore underlying mechanisms and implications for systems\u2010 and practice\u2010based changes in the United States.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/birt.70012","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T07:39:16Z","timestamp":1757662756000},"page":"181-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Birth Outcomes for Obstetrician\u2010 or Midwife\u2010Led Intrapartum Care"],"prefix":"10.1111","volume":"53","author":[{"given":"Natalie T.","family":"Simon","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8975-5059","authenticated-orcid":false,"given":"Trisha","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Lijewski","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Anderson","sequence":"additional","affiliation":[{"name":"University of Colorado College of Nursing University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Colorado College of Nursing University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanelle","family":"Sheeder","sequence":"additional","affiliation":[{"name":"Division of Family Planning, Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Schulkin","sequence":"additional","affiliation":[{"name":"Pregnancy Related Care Research Network, Department of Obstetrics and Gynecology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6906-350X","authenticated-orcid":false,"given":"K. Joseph","family":"Hurt","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"},{"name":"Division of Reproductive Sciences, Department of Obstetrics and Gynecology University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","first-page":"1","article-title":"Births: Final Data for 2021","volume":"72","author":"Osterman M. J. 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