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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program


Year Degree Awarded


Month Degree Awarded


First Advisor

Annette Wysocki

Second Advisor

Karen Kalmakis

Third Advisor

Lynnette Sievert

Fourth Advisor

Lisa Chiodo

Subject Categories

Maternal, Child Health and Neonatal Nursing | Nursing Midwifery



Language acquisition is the primary marker of acculturation to the dominant society in a receiving geographic area, and effective communication in English is a marker of acculturation in the United States. There is good evidence that women who receive midwifery care have improved maternal outcomes, and that women who are not well acculturated to the dominant culture in the United States have improved neonatal outcomes. However, the maternal outcomes of women who do not communicate in English are not well studied, nor is it known whether care during parturition by physicians when compared to nurse midwives makes a difference in such women.

The purpose of this study was to determine whether there was a difference in maternal outcomes, defined as labor interventions and delivery methods, in childbearing women who were or were not able to communicate in English, or in childbearing women who used midwifery versus physician care. The moderating influence of the care provider type on language use and maternal outcomes were also studied.


This quantitative, retrospective study was conducted using analysis of labor, delivery, language, and care provider data extracted from electronic health records of women during their labor and delivery. Electronic health records of parturient patients admitted for delivery between 23 and 42 weeks’ gestation were analyzed from 2013-2016 (N=11,656) from a tertiary care center in New England. Data were analyzed using descriptive statistics and Chi squared (χ 2 {\displaystyle \chi ^{2}}χ2) using SPSS.

Findings: Women had improved delivery outcomes if they were unable to communicate in English when compared to English speaking women or women who stated they could communicate in English, but later needed an interpreter. Women who utilized midwifery services had equal or improved maternal outcomes when compared to women who utilized physician services.

Conclusions: Healthy Migrant Theory was substantiated or not refuted in most variables, and women who did not speak English and who used midwives for care were more likely to achieve vaginal deliveries, vaginal birth after cesarean, and significantly less likely to have cesarean deliveries. All women, no matter what language used, should receive equivalent care during labor and delivery.