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: 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

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 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

• 84% - gave birth in birth center

• 93% - normal vaginal birth

• 6% - cesarean birth

• 1% operative vaginal birth (forceps or vacuum)

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

• 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

• 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

• 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

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

• 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