Distribution and Adequacy of Delivery Care Providers in the United States Open Access

Vanderlaan, Jennifer (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/sn009x97b?locale=en


Obstetrician benchmarks have been used to measure maternity care workforce adequacy in the United States since 1981. These measures are not precise enough to capture evolving differences in non-physician workforce, nor do they allow for regional differences in fertility rates. Using GIS technology to compare the distribution of areas with adequate workforce reveals differences between obstetrician to population measures and obstetrician equivalent to birth measures. Using a measure of adequacy that includes a count of midwives reveals associations between policies regulating midwifery practice and proportion of areas with adequate delivery workforce.

Table of Contents

Table of Figures

Part One: Introduction 1

Introduction and Rationale 1

Problem Statement 6

Purpose Statement 12

Research Questions 13

Significance Statement 13

Definition of Terms 14

Chapter Two: Literature Review 15

Delivery Care Provider Workforce Benchmarking 15

Obstetricians 16

Family Practice Physicians 20

Midwives 21

Geographic Studies. 25

Summary of Current Problem and Relevance 26

Chapter Three: Methodology 28

Introduction 28

Population and Sample 28

Research Design 30

Procedures 31

Limitations and Delimitations 32

Chapter Three: Results 33

Findings 33

Distribution of Delivery Care Providers at the County Level 33

Adequacy of the workforce at the County Level 38

Distribution of Delivery Care Providers at the Health Service Area Level 46

Adequacy of the workforce at the Health Service Area Level 50

Association of state midwifery policy with adequacy of the workforce 55

Other Findings 61

Summary 62

Chapter Five: Discussion 62

Chapter Six: Implications/Recommendations 65

Appendix A: Summary of Direct Entry Midwifery Laws with Sources for Direct Entry Midwifery Data 67

Appendix B: Summary of Midwifery Written Practice Agreement Laws by State(ACNM, 2011) 70

Appendix C: Difference between Obstetrician to Population and Obstetrician to D Measures of Adequacy 72

References 73

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