Outcomes of care in birth centers demonstration of a durable model
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Outcomes of Care in Birth Centers: Demonstration of a Durable Model. Susan Stapleton, DNP, CNM Cara Osborne, SD, CNM Jessica Illuzzi , MD, MS. Study Design. Objective : D escribe current outcomes for birth centers in the U.S.

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Outcomes of care in birth centers demonstration of a durable model

Outcomes of Care in Birth Centers: Demonstration of a Durable Model

Susan Stapleton, DNP, CNM

Cara Osborne, SD, CNM

Jessica Illuzzi, MD, MS


Study design
Study Design

Objective: Describe current outcomes for birth centers in the U.S.

Design: Prospective, cohort study of births in midwifery-led 79 birth centers from 2007-2010.

Sample: 22,403 women planning to give birth in birth center when registering for prenatal care

Data Collection: AABC Uniform Data Set™


Study sample
Study Sample

Eligibility criteria to give birth in birth center:

  • Singleton pregnancy

  • Vertex presentation (head down)

  • Full term (> 37 weeks of pregnancy)

  • No medical or obstetric risk factors precluding normal vaginal birth or requiring interventions such as continuous electronic fetal monitoring or induction of labor


  • Study sample1
    Study Sample

    • 15,574 women remained in birth center care & were eligible to give birth in birth center at onset of labor.

    • Federal or state government programs (Medicaid, Medicare, CHIP, or TRICARE) were payers for nearly 1/3 of births in study.


    Outcomes
    Outcomes

    • 84% - gave birth in birth center

    • 93% - normal vaginal birth

    • 6% - cesarean birth

    • 1% operative vaginal birth (forceps or vacuum)


    Outcomes1
    Outcomes

    • Fetal & newborn mortality rates were low & comparable to low-risk births in hospitals

    • 0.47 stillbirths per 1,000 women (.047%)

    • 0.40 newborn deaths per 1,000 women (.04%)


    Transfers during labor
    Transfers during Labor

    • 4.5% referred to hospital in labor prior to admission to birth center

    • 12% transferred to hospital in labor after admission to birth center

    • 94% of those transfers to hospital in labor were non-emergency e.g. prolonged labor

    • Less than 1% (0.9%, n=140) required emergency transfer during labor


    Transfers after birth
    Transfers after Birth

    • 2.4% of mothers transferred after giving birth (0.4% were emergency)

    • 2.2% of infants transferred after birth

      (0.6% were emergency)


    Summary of study results
    Summary of Study Results

    • 13,030 (84%) of women planning birth center birth at onset of labor gave birth at birth center

    • Fewer than 1 in 16 (6%) had cesarean birth

    • Need for emergency transfer was rare

      • 1.3% of mothers (140 in labor & 67 postpartum)

      • 0.6% of newborns (97)


    Summary of study findings
    Summary of Study Findings

    In over 2 decades of increasing intervention in childbirth nationally with no improvement in outcomes…..

    Birth center outcomes have remained remarkably consistent


    Research on birth centers
    Research on Birth Centers

    • Birth centers are safe – maternal & neonatal outcomes as good or better than those of low risk women giving birth in hospitals

    • Birth centers have lower rates of cesarean birth & other interventions than “usual” care – including those of hospital-based CNM care

    • Consumer satisfaction with birth center care is high

    • Potential cost-savings


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