Background A recent Center for Medicare and Medicaid Innovation report evaluated the four‐year Strong Start for Mothers and Newborns Initiative, which sought to improve maternal and newborn outcomes through exploration of three enhanced, evidence‐based care models. This paper reports the socio‐demographic characteristics, care processes, and outcomes for mothers and newborns engaged in care with American Association of Birth Centers (AABC) sites. Methods The authors examined data for 6424 Medicaid or Children's Health Insurance Program (CHIP) beneficiaries in birth center care who gave birth between 2013 and 2017. Using data from the AABC Perinatal Data Registry™, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Comparisons are made between outcomes in the AABC sample and national data during the study period. Results Childbearing mothers enrolled at AABC sites had diverse socio‐behavioral risk factors similar to the national profile. The AABC sites exceeded national quality benchmarks for low birthweight (3.28%), preterm birth (4.42%), and primary cesarean birth (8.56%). Racial disparities in perinatal indicators were present within the Strong Start sample; however, they were at narrower margins than in national data. The enhanced model of care was notable for use of midwifery‐led prenatal, labor, and birth care and decreased hospital admission. Conclusions Birth center care improves population health, patient experience, and value. The model demonstrates the potential to decrease racial disparity and improve population health. Reduction of regulatory barriers and implementation of sustainable reimbursement are warranted to move the model to scale for Medicaid beneficiaries nationwide.
Introduction:The birth center, a relatively recent innovation in maternity care, is an increasingly popular location of birth. The purpose of this integrative literature review is to assess the research on maternal outcomes from birth center care. Methods:Using methods by Whittemore and Knafl, we conducted an integrative review of studies of birth centers published in English since 1980. Twenty-three quantitative sources and 9 qualitative sources describing maternal outcomes of birth center care were reviewed and synthesized.Results: Outcomes for women receiving birth care were positive. Spontaneous vaginal birth rates and perineal integrity were higher for women beginning care in a birth center compared to women in hospital care. Rates of cesarean birth were also lower for women planning birth center care. Transfer rates are difficult to compare across studies, but antepartum transfer rates ranged from 13% to 27.2%. Intrapartum transfer rates ranged from 11.6% to 37.4%, and from 11.6% to 16.5% in studies published from 2011 to 2013. Nulliparous women had higher rates of transfer than multiparous women. Few severe maternal outcomes and no maternal deaths were reported in any studies. Women were satisfied with the comprehensive, personalized care that they received from birth centers.Discussion: Quantitative studies reviewed included more than 84,300 women. The heterogeneity of the studies and variations of practice limit generalization of findings. However, even with multisite studies enrolling a variety of birth centers and practice changes over time, the consistency of positive outcomes supports this model of care. Policy makers in the United States should consider supporting the birth center model as a means of improving maternal outcomes.
BackgroundVariations in care for pregnant women have been reported to affect pregnancy outcomes.MethodsThis study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored.ResultsMedicaid beneficiaries enrolled at AABC sites had diverse socio‐behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low‐risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery‐led prenatal care, and 84% with midwifery‐ attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4‐times greater risk of cesarean birth among medically low‐risk childbearing Medicaid beneficiaries.ConclusionsThe birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.
Purpose To explore the role of the birth center model of care in rural health and maternity care delivery in the United States. Methods All childbearing families enrolled in care at an American Association of Birth Centers Perinatal Data RegistryTM user sites between 2012 and 2020 are included in this descriptive analysis. Findings Between 2012 and 2020, 88 574 childbearing families enrolled in care with 82 American Association of Birth Centers Perinatal Data RegistryTM user sites. Quality outcomes exceeded national benchmarks across all geographic regions in both rural and urban settings. A stable and predictable rate of transfer to a higher level of care was demonstrated across geographic regions, with over half of the population remaining appropriate for birth center level of care throughout the perinatal episode of care. Controlling for socio demographic and medical risk factors, outcomes were as favorable for clients in rural areas compared with urban and suburban communities. Conclusions Rural populations cared for within the birth center model of care experienced high‐quality outcomes. Health Policy Implications A major focus of the United States maternity care reform should be the expansion of access to birth center models of care, especially in underserved areas such as rural communities.
There are substantial flaws in the literature concerning the effect of birth center care on neonatal outcomes. More research is needed on subgroups at risk of poor outcomes in the birth center environment. To expedite research, consistent use of national and international definitions of perinatal and neonatal mortality within data registries and greater detail on adverse outcomes would be beneficial.
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