Jackson CB; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 112.
Department of Sociology, Rutgers University, Piscataway, NJ 08854-8045, USA.
RESEARCH OBJECTIVE: At the turn of the 20th Century, midwives attended 50% of births; by 1970, less than 1%. Scholars attribute this decline to a variety of factors, including the professionalization of the male-dominated medical profession during the early decades of the 20th Century. Some scholars suggest that demographics of the workforce (doctors were men, midwives were women) determined the outcome of the struggle for jurisdiction over childbirth. Since 1970, the percent of births attended by Certified Nurse Midwives (CNMs) has increased (up to 6% in 1996). At the same time, women have entered the medical profession in great numbers. While women are entering medicine in greater numbers, they are not evenly distributed across the profession. Women are more likely to practice in family or general medicine, pediatrics, Ob/Gyn, anesthesiology, psychiatry and public health. In 1995, 30% of all Ob/Gyns were women - much higher than the 21% percent of all physicians that were women. This paper considers the consequence of demographic changes within the medical profession for jurisdictional boundaries between Ob/Gyns and CNMs. STUDY DESIGN: Data for this analysis were gathered from a variety of sources, including: National Center for Health Statistics (CNM attended births, 1996); American Medical Association (percent of Obstetricians/Gynecologists and Physicians who are female, 1995); and the American College of Nurse Midwives (state policies that regulate CNMs, 1997). Data were entered into and analyzed using SPSS, 8.0. Bivariate correlations and multiple regression are used to determine the impact of occupational feminization of obstetrics on the percent of births attented by CNMs, controlling for state policy, supply of CNMs and percent of all physicians that are females. Geographic Information Systems is also used to generate maps that reflect the spatial relationship between the occupational feminization of Ob/Gyn and percent of births attended by CNMs. PRINCIPAL FINDINGS: Bivariate analyses revealed significant positive correlations between percent of births attended by CNMs and supply of CNMs, percent of Ob/Gyns that are female, percent of physicians that are female and state policies that regulate midwives. Multiple Regression showed that 61% (p<.001) of the variability in percent of births attended by CNMs is accounted for by the study variables. Supply of CNMs is the biggest predictor of percent of births attended by CNMs (b=.62, p<.001). In addition, the percent of Ob/Gyns that are female (independent of CNM, percent of physicians that are female and state policy) increases the percent of births attended by CNMs by .16% (p<.05). CONCLUSIONS: The study provides evidence that the changing sex composition of an occupation has implications for jurisdictional boundaries within the system of professions. Specifically, these findings suggest that occupational feminization increases the percent of births attended by CNMs within states. As more and more women enter Ob/Gyn practice, the sexed division of labor between CNMs and Ob/Gyns breaks down. At the turn of the century, when midwives began declining, doctors were men and midwives were women. As this is no longer the case, that is one less distinction between the 2 professional groups. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: These findings are useful for understanding demographic changes shape interprofessional relations. This analysis considers macro-level variables that effect service delivery. Further research that considers interprofessional relations within the workplace is necessary to understand how these dynamics effect individual providers and recipients of care.
Publication Types:
Keywords:
- Child
- Delivery, Obstetric
- Demography
- Female
- Gynecology
- Home Childbirth
- Humans
- Labor, Induced
- Male
- Midwifery
- Natural Childbirth
- Nurse Midwives
- Obstetrics
- Parturition
- Physicians
- Physicians, Family
- Pregnancy
- surgery
- hsrmtgs
Other ID:
UI: 102194364
From Meeting Abstracts