Study Affirms Safety, Low Intervention Rates of Birth Center Care

February 28, 2013 — "Outcomes of Care in Birth Centers: Demonstration of a Durable Model," Rutledge Stapleton et al., Journal of Midwifery & Women's Health, January/February 2013.

"Childbirth is the leading cause of hospitalization in the United States," accounting for $97.4 billion in health care spending in 2008, according to Susan Rutledge Stapleton, a certified nurse midwife, and colleagues.

Various entities -- including the Centers for Medicaid and Medicare Services, the Institute of Medicine, and Childbirth Connection -- have called for further research on the birth center model as a means of providing less-costly, high-quality care, the researchers noted. Additionally, the "concept of better outcomes at lower costs, or 'high value' care, is a driving force" behind the Affordable Care Act (PL 111-148), which mandates "payments for facility services to birth centers across the United States," they added.

Their study examined outcomes of women who gave birth in birth centers, which the American Association of Birth Centers defines as "a homelike facility existing within a health care system with a program of care designed in the wellness model of pregnancy and birth."

Methods

The researchers conducted a prospective cohort study to assess intrapartum care and perinatal outcomes of women who presented in labor at 79 midwifery-led birth centers in 33 states from 2007 through 2010. They used data from the AABC Uniform Data Set (UDS), an online registry that includes 189 variables on women receiving care in birth centers, such as demographics, risk factors, processes of care and maternal-infant care outcomes. All women included in the study had planned to give birth at a birth center and were medically eligible to do so.

Results

A total of 15,574 women who planned to give birth in a birthing center at the onset of labor were included in the study results. Most were white, between ages 18 and 34, and had obtained college degrees.

Among all participants, 95.6% of the women were admitted to the birth center in labor, while 4.5% were referred to a hospital first. Ultimately, 84% of all participants gave birth at the birth center, 12% were transferred to a hospital after being admitted to the birth center and 4% were transferred to a hospital prior to birth center admission.

The vast majority of births were spontaneous vaginal births (92.8%), while caesarean section births (6.1%) and assisted vaginal births (1.2%) were less common.

There were no maternal deaths; 14 fetal deaths, half of which occurred before women arrived at the birth center; and nine neonatal deaths, seven of which were expected because of fetal anomalies.

Discussion

The study results are consistent with previous research on midwifery-led care, suggesting that such care "is a safe and effective option for medically low-risk women," according to the researchers. The fetal and neonatal mortality rates also are comparable to those in other studies of low-risk women in various settings, they added.

The researchers noted that the rate of c-section births in the study group was 6%, compared with an estimated 25% in a hospital setting for similar women. They also pointed out that fewer than 2% of women or newborns in the study required an emergency transfer to a hospital.

"The potential savings from the cost of care and lower intervention rates highlight birth centers as an important option for providing high-value maternity care," the researchers wrote. They called for additional research analyzing the cost of birth center care and stressed the importance of "fair and timely reimbursement" in ensuring "the sustainability and further dissemination of the model."

The study showed that "[b]irth centers and their midwifery-led, collaborative model of maternity care continue to offer an important solution to many of the issues affecting the quality and cost of maternity care in the United States," the researchers wrote, concluding that the findings add "to the evidence demonstrating excellent maternal and infant outcomes for women receiving midwifery-led care in birth centers."