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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. 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

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  1. Outcomes of Care in Birth Centers: Demonstration of a Durable Model Susan Stapleton, DNP, CNM Cara Osborne, SD, CNM Jessica Illuzzi, MD, MS

  2. 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™

  3. 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

  4. 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.

  5. Outcomes • 84% - gave birth in birth center • 93% - normal vaginal birth • 6% - cesarean birth • 1% operative vaginal birth (forceps or vacuum)

  6. 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%)

  7. 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

  8. 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)

  9. 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)

  10. 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

  11. 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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