Midwifery Care and Patient–Provider Communication in Maternity Decisions in the United States

To characterize reasons women chose midwives as prenatal care providers and to measure the relationship between midwifery care and patient–provider communication in the U.S. context. Retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 to a single newborn in a U.S. hospital (n = 2,400). We used multivariate logistic regression models to characterize women who received prenatal care from a midwife, to describe the reasons for this choice, and to examine the association between midwife-led prenatal care and women’s reports about communication. Preference for a female clinician and having a particular clinician assigned was associated with higher odds of midwifery care (AOR = 2.65, 95 % CI 1.70, 4.14 and AOR = 1.63, 95 % CI 1.04, 2.58). A woman with midwifery care had lower odds of reporting that she held back questions because her preference for care was different from her provider’s recommendation (AOR = 0.46, 95 % CI 0.23, 0.89) or because she did not want to be perceived as difficult (AOR = 0.48, 95 % CI 0.28, 0.81). Women receiving midwifery care also had lower odds of reporting that the provider used medical words were hard for them to understand (AOR = 0.58, 95 % CI 0.37, 0.91) and not feeling encouraged to discuss all their concerns (AOR = 0.54, 95 % CI 0.34, 0.89). Women whose prenatal care was provided by midwives report better communication compared with those cared for by other types of clinicians. Systems-level interventions, such as assigning a clinician, may improve access to midwifery care and the associated improvements in patient–provider communication in maternity care.