Document Type


Date of Degree Completion

Spring 2023

Degree Name

Master of Public Health (MPH)


Health Sciences

Committee Chair

Dr. Casey Mace Firebaugh

Second Committee Member

Dr. Katarina Mucha

Third Committee Member

Dr. Melody Madlem


Despite making up only 3% of the U.S. population, American Indian/Alaska Native (AI/AN) individuals have the second highest maternal mortality rate in the United States, and the leading cause of maternal mortality and morbidity among AI/AN is postpartum hemorrhage. Many interventions used during childbirth have been identified as common causes of hemorrhage, such as lacerations of the vagina and cervix, operative vaginal deliveries, & augmentation of labor. Research has found that individuals who had midwives as their care providers have been found to be less likely to experience instrumental deliveries, epidural analgesia, labor augmentation, episiotomy or perineal lacerations, cesarean sections, and postpartum hemorrhage. While many research studies have found these associations, the specific population of American Indian/Alaska Native birthing people has not been investigated for these potential benefits. The purpose of this quantitative study was to compare the labor interventions and maternal health outcomes between American Indian and Alaska Native birthing people who received care from midwives to those who received care from physicians.

Using secondary birth data obtained from the Oregon Health Authority, labor interventions and morbidity outcomes and type of birth attendant were tested for association using chi-square tests. Relative risks were then calculated for each intervention and outcome. Results found that for all labor interventions, care provided by midwives was associated with statistically less intervention. There was no statistically significant difference between the midwife and physician group for perineal lacerations. Results from this study could support future advocacy and policy work to encourage greater use of the midwifery-led continuity model of care to help improve and strengthen the maternal health of American Indians and Alaska Natives.