{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:45:59Z","timestamp":1773006359044,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T00:00:00Z","timestamp":1568073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS023801"],"award-info":[{"award-number":["R01HS023801"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Despite evidence supporting the safety of low\u2010interventional approaches to intrapartum care, defined by the American College of Obstetricians and Gynecologists as \u201cpractices that facilitate a physiologic labor process and minimize intervention,\u201d little is known about how frequently such practices are utilized. We examined hospital use of low\u2010interventional practices, as well as variation in utilization across hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data came from 185 California hospitals completing a survey of intrapartum care, including 9 questions indicating use of low\u2010 versus high\u2010interventional practices (eg, use of intermittent auscultation, nonpharmacologic pain relief, and admission of women in latent labor). We performed a group\u2010based latent class analysis to identify distinct groups of hospitals exhibiting different levels of utilization on these 9 measures. Multivariable logistic regression identified institutional characteristics associated with a hospital's likelihood of using low\u2010interventional practices. Procedure rates and patient outcomes were compared between the hospital groups using bivariate analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 2 distinct groups of hospitals that tended to use low\u2010interventional (n = 44, 23.8%) and high\u2010interventional (n = 141, 76.2%) practices, respectively. Hospitals more likely to use low\u2010interventional practices included those with midwife\u2010led or physician\u2010midwife collaborative labor management (adjusted odds ratio [aOR], 7.52; 95% CI, 2.53\u201022.37; <jats:italic>P<\/jats:italic> &lt; .001) and those in rural locations (aOR, 3.73; 95% CI, 1.03\u201013.60; <jats:italic>P<\/jats:italic> = .04). Hospitals with a higher proportion of women covered by Medicaid or other safety\u2010net programs were less likely to use low\u2010interventional practices (aOR, 0.96; 95% CI, 0.93\u20100.99; <jats:italic>P<\/jats:italic> = .004), as were hospitals in counties with higher medical liability insurance premiums (aOR, 0.53; 95% CI, 0.33\u20100.85; <jats:italic>P<\/jats:italic> = .008). Hospitals in the low\u2010intervention group had comparable rates of severe maternal and newborn morbidities but lower rates of cesarean birth and episiotomy compared with hospitals in the high\u2010intervention group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Only one\u2010quarter of hospitals used low\u2010interventional practices. Attention to hospital culture of care, incorporating the midwifery model of care, and addressing medical\u2010legal concerns may help promote utilization of low\u2010interventional intrapartum practices.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jmwh.13017","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T08:05:23Z","timestamp":1568102723000},"page":"33-44","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Low\u2010Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-511X","authenticated-orcid":false,"given":"Lisbet S.","family":"Lundsberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Yale University School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elliott K.","family":"Main","sequence":"additional","affiliation":[{"name":"California Maternal Quality Care Collaborative  Stanford California"},{"name":"Department of Obstetrics and Gynecology Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry C.","family":"Lee","sequence":"additional","affiliation":[{"name":"California Perinatal Quality Care Collaborative  Stanford California"},{"name":"Department of Pediatrics Stanford University School of Medicine  Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiqun","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Yale University School of Public Health  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Illuzzi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Yale University School of Medicine  New Haven Connecticut"},{"name":"Laborists and Midwifery Section Yale Medicine  New Haven Connecticut"},{"name":"Vidone Birthing Center Yale New Haven Hospital, Saint Raphael Campus  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences Yale University School of Medicine  New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,10]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Choosing Wisely.American Board of Internal Medicine (ABIM) website.https:\/\/abimfoundation.org\/what-we-do\/choosing-wisely. 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American Hospital Association (AHA) Dataviewer website.https:\/\/www.ahadataviewer.com\/additional-data-products\/AHA-Survey\/. Accessed May 1 2018."},{"key":"e_1_2_7_18_1","unstructured":"Hospital Financials. California Office of Statewide Health Planning and Development (OSHPD) website.https:\/\/oshpd.ca.gov\/data-and-reports\/cost-transparency\/hospital-financials\/. Accessed June 30 2019."},{"key":"e_1_2_7_19_1","unstructured":"California Perinatal Quality Care Collaborative (CPQCC) website.https:\/\/www.cpqcc.org\/. Accessed May 1 2018."},{"key":"e_1_2_7_20_1","unstructured":"Find a Magnet facility. American Nurses Credentialing Center website.https:\/\/www.nursingworld.org\/organizational-programs\/magnet\/find-a-magnet-facility\/. 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Providence RI: National Perinatal Information Center; 2015.http:\/\/www.npic.org\/wp-content\/uploads\/2018\/11\/DBAnalysis_Severe_Maternal_Morbidity_2015-04.pdf. Accessed July 2 2019."},{"key":"e_1_2_7_26_1","unstructured":"National Quality Forum.Perinatal and Reproductive Health 2015\u20102016 Final Report. Washington DC: National Quality Forum;2016.http:\/\/www.qualityforum.org\/Publications\/2016\/12\/Perinatal_and_Reproductive_Health_2015-2016_Final_Report.aspx. Accessed May 19 2018."},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.09.034"},{"key":"e_1_2_7_28_1","unstructured":"SkrondalA Rabe\u2010HeskethS.Generalized Latent Variable Modeling: Multilevel Longitudinal and Structural Equation Models. 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