{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T10:59:18Z","timestamp":1786273158623,"version":"build-2736575974"},"reference-count":46,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T00:00:00Z","timestamp":1645315200000},"content-version":"vor","delay-in-days":365,"URL":"http:\/\/www.sagepub.com\/licence-information-for-chorus"}],"funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HU0001-11-1-0023"],"award-info":[{"award-number":["HU0001-11-1-0023"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America\u2019s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012\u20132014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction\/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women\u2019s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.<\/jats:p>","DOI":"10.1177\/1527154421994071","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T22:27:02Z","timestamp":1613860022000},"page":"105-113","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1984-621X","authenticated-orcid":false,"given":"Lynette","family":"Hamlin","sequence":"first","affiliation":[{"name":"Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Grunwald","sequence":"additional","affiliation":[{"name":"Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney X.","family":"Sturdivant","sequence":"additional","affiliation":[{"name":"Henry Jackson Foundation, Bethesda, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey P.","family":"Koehlmoos","sequence":"additional","affiliation":[{"name":"Health Services Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,2,20]]},"reference":[{"key":"bibr1-1527154421994071","first-page":"9","volume":"8","author":"Adams E. K.","year":"2018","journal-title":"Policy Proposal"},{"key":"bibr3-1527154421994071","unstructured":"American Association of Nurse Practitioners. (2019).\n                      2019 Nurse practitioner state practice environment\n                      . https:\/\/storage.aanp.org\/www\/documents\/state-leg-reg\/stateregulatorymap.pdf"},{"key":"bibr4-1527154421994071","unstructured":"American College of Nurse-Midwives. (2012).\n                      Definition of midwifery and scope of practice of certified nurse-midwives and certified midwives\n                      ."},{"key":"bibr5-1527154421994071","unstructured":"American College of Nurse-Midwives. (2016).\n                      Map: Regulatory environment for certified nurse-midwives and certified midwives\n                      . http:\/\/www.midwife.org\/acnm\/files\/ccLibraryFiles\/Filename\/000000006466\/Quick%20Reference_Practice%20Environment_July%202016.pdf"},{"key":"bibr6-1527154421994071","unstructured":"American College of Nurse-Midwives. (2018).\n                      Joint statement of practice relations between obstrician\/gycecologists and certified nurse-midwives\/certified midwives\n                      . http:\/\/midwife.org\/ACNM\/files\/ACNMLibraryData\/UPLOADFILENAME\/000000000224\/ACNM-College-Policy-Statement-(June-2018).pdf"},{"key":"bibr7-1527154421994071","unstructured":"American College of Nurse-Midwives. (2019).\n                      Pathways to midwifery education\n                      . https:\/\/portal.midwife.org\/education\/education-pathway?reload=timezone"},{"key":"bibr8-1527154421994071","unstructured":"American Midwifery Certification Board. (2018a).\n                      2018 Annual report."},{"key":"bibr9-1527154421994071","unstructured":"American Midwifery Certification Board. (2018b).\n                      About the task analysis\n                      . https:\/\/www.amcbmidwife.org\/about-amcb\/task-analysis"},{"key":"bibr10-1527154421994071","author":"Attanasio L. B.","year":"2019","journal-title":"Birth"},{"key":"bibr11-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2018.01.018"},{"key":"bibr12-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12334"},{"key":"bibr13-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00265"},{"key":"bibr1114-1527154421994071","unstructured":"Department of Veterans Affairs, Veterans Health Administration (2017). Advanced Practice Registered Nurse Full Practice Authority. VHA Directive 1350. Washington DC."},{"key":"bibr14-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1177\/0193945916689084"},{"key":"bibr15-1527154421994071","unstructured":"The LeapFrog Group. (2018).\n                      Maternity care\n                      . https:\/\/www.leapfroggroup.org\/sites\/default\/files\/Files\/leapfrog_castlight_maternity_care_2018%20report.pdf"},{"key":"bibr16-1527154421994071","unstructured":"Hamilton B. E., Martin J. A., Osterman M. J., Curtin S. C., Mathews T. (2015).\n                      Births: Final data for 2014.\n                      U.S. Department of Health and Human Services."},{"key":"bibr17-1527154421994071","unstructured":"Hamilton B. E., Martin J. A., Osterman M. J., Rossen L. M. (2019).\n                      Births: Provisional data for 2018\n                      . U.S. Department of Health and Human Services."},{"key":"bibr18-1527154421994071","doi-asserted-by":"crossref","unstructured":"Hosmer D. W.Jr., Lemeshow S., Sturdivant R. X. (2013).\n                      Applied logistic regression\n                      (Vol. 398). John Wiley & Sons.","DOI":"10.1002\/9781118548387"},{"key":"bibr19-1527154421994071","unstructured":"Improving Access to Maternity Care Act, Pub. L. No. 115-320, HR 315 Stat. (December 17, 2018)."},{"key":"bibr20-1527154421994071","volume-title":"The future of nursing: Leading change, advancing health","author":"Institute of Medicine","year":"2011"},{"key":"bibr21-1527154421994071","unstructured":"International Confederation of Midwives. (2017).\n                      ICM definition of the midwife.\n                      https:\/\/www.internationalmidwives.org\/assets\/files\/definitions-files\/2018\/06\/eng-definition_of_the_midwife-2017.pdf"},{"key":"bibr22-1527154421994071","unstructured":"International Confederation of Midwives. (2018).\n                      Essential competencies for midwifery practice\n                      . https:\/\/www.internationalmidwives.org\/assets\/files\/general-files\/2018\/10\/icm-competencies\u2013-english-document_final_oct-2018.pdf"},{"key":"bibr23-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2011.06.005"},{"key":"bibr24-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12361"},{"key":"bibr25-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1097\/01.NPR.0000502792.43113.73"},{"key":"bibr26-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12750"},{"key":"bibr27-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2017.07.004"},{"key":"bibr28-1527154421994071","unstructured":"Martin J. A., Hamilton B. E., Osterman M. J., Curtin S. C., Mathews T. (2015).\n                      Births: Final data for 2013\n                      . National Center for Health Statistics."},{"key":"bibr29-1527154421994071","unstructured":"Martin Joyce A., Hamilton B. E., Osterman M. J., Curtin S. C., Mathews T. (2013).  Births: Final data for 2012. National Vital Statistics Reports,  62(9), 1\u201387."},{"key":"bibr30-1527154421994071","unstructured":"MHS.\n                      About the military health system\n                      . https:\/\/www.health.mil\/About-MHS"},{"key":"bibr31-1527154421994071","doi-asserted-by":"crossref","unstructured":"Myers L., Stevens J. (2016). Using EHR to conduct outcome and health services research. In Secondary analysis of electronic health records (pp. 61\u201370). Springer.","DOI":"10.1007\/978-3-319-43742-2_7"},{"key":"bibr32-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0077"},{"key":"bibr33-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.11.014"},{"key":"bibr34-1527154421994071","unstructured":"Oliove M. (2016).\n                      A shortage in the nation's maternal health care\n                      . https:\/\/www.pewtrusts.org\/en\/research-and-analysis\/blogs\/stateline\/2016\/08\/15\/a-shortage-in-the-nations-maternal-health-care"},{"key":"bibr35-1527154421994071","unstructured":"Rayburn W. F. (2017). The obstetrician-gynecologist workforce in the United States: Facts, figures, and implications."},{"key":"bibr36-1527154421994071","unstructured":"Reforming America's Healthcare System Through Choice and Competition. (2018). https:\/\/www.hhs.gov\/sites\/default\/files\/Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pdf"},{"key":"bibr37-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12442"},{"key":"bibr38-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2018.05.004"},{"key":"bibr39-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001032"},{"key":"bibr40-1527154421994071","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.00862"},{"key":"bibr41-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001958"},{"key":"bibr42-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31822ac86f"},{"key":"bibr43-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003521"},{"key":"bibr44-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12638"},{"key":"bibr45-1527154421994071","unstructured":"Westat. (2015).\n                      Impact of state scope of practice laws and other factors on the practice and supply of primary care nurse practitioners: Final report\n                      ."},{"key":"bibr46-1527154421994071","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2016.02.003"}],"container-title":["Policy, Politics, &amp; Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154421994071","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1527154421994071","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154421994071","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154421994071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:48:56Z","timestamp":1777700936000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1527154421994071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,20]]},"references-count":46,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1177\/1527154421994071"],"URL":"https:\/\/doi.org\/10.1177\/1527154421994071","relation":{},"ISSN":["1527-1544","1552-7468"],"issn-type":[{"value":"1527-1544","type":"print"},{"value":"1552-7468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,20]]}}}