Decades of research show that outcomes of care provided by certified nurse-midwives compare favorably to care provided by physicians. In recent studies, multiple outcomes were examined comparing care provided by certified nurse-midwives and physician colleagues. The results determined that women cared for by CNMs of the same risk status that were cared for by physicians had lower cesarean birth rates, lower rates of labor induction and augmentation, significant reduction in the number of third and fourth degree perineal tears, lower epidural usage, and higher breastfeeding rates.