Association for Public Policy Analysis & Management

The average uncomplicated pregnancy and birth costs $9,577 (Machlin & Rhode, 2007), and the US spends approximately $38 billion on uncomplicated childbirths every year. Other developed countries have lower costs partly because they rely heavily on the midwife model of care. In 2013 less than 9 percent of American births were attended by a midwife compared to 70% in many European countries (Martin et al., 2015; Emons & Luiten, 2001). Achieving high midwife delivery rates requires collaboration between midwives and OBs, and collaboration depends on mutual respect for and understanding of the different philosophies, skills, and roles offered by the two professions. Interdisciplinary training programs are one strategy for promoting the collaboration required for broader use of midwives.

This study evaluates the extent to which cross-disciplinary collaboration in the provision of childbirth services is explained by the co-location of obstetric (OB) and midwife training programs. The study has two main research objectives. First, we will construct a data set measuring the prevalence and distribution of co-located OB and midwife training programs. Data on training program locations come from Integrated Postsecondary Education Data System (IPEDS), and the Association of American Medical Colleges (AAMC). Second, we will construct measures of collaboration in childbirth services markets across the country. One way to measure collaboration is to construct measures of the relative complexity of OB deliveries in a given geographical area. We hypothesize that in geographic areas with little cooperation between OBs and midwives, OBs may deliver both low and high-risk patients. Alternatively, in an area with efficient collaboration, OBs are likely to focus their practice on delivering more complex births that require their expertise relative to midwives. Data on childbirth services and outcomes come from Natality Detail Files (NDF) from the National Vital Statistics System (NVSS) of the National Center for Health Statistics. Work on the project has started and preliminary results from the analysis will be available in time for the conference.