Introduction
The role of the certified nurse midwife (CNM) during labor and delivery varies greatly around the world1 and the appropriate model of maternity care is a matter of debate2. While in some countries physicians are the primary care providers, there are countries where the model of ”midwifery continuity of care” prevails. The most prevalent and typical model of maternity care is a medically led system with varying levels of midwifery input, referred to as ”shared model of care” 2. According to a recent Cochrane review, parturients in the midwife led continuity of care model as oppose to other models of care were less likely to undergo an episiotomy and there were no reported differences in maternal antepartum and postpartum hemorrhage and neonatal Apgar scores2.
In recent years the impact of the individual practitioner’s workload as well as medical center volume on patients’ outcome has been a matter of growing interest 3–6; Specifically in the obstetric practice, studies showed an increased rate of adverse maternal and neonatal outcomes among low obstetric volume hospitals.
Although there exists considerable amount of literature on the different models of care and center obstetrical volume, there is a paucity of information with respect to the association between the individual CNM’s experience and adverse maternal and neonatal outcomes. In the present study, we aim to examine the relationship between the individual CNM workload, measured by annual volume per CNM, and adverse maternal and neonatal outcomes.