Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison

Thornton, Patrick; McFarlin, Barbara L.; Park, Chang Gyu; Rankin, Kristin; Schorn, Mavis N.; Finnegan, Lorna; Stapleton, Susan R.

doi:10.1111/jmwh.12553

Cited by 20 publications

(48 citation statements)

References 26 publications

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“…Seventeen studies were included (Table ). There are 7 studies set in the United States, 2 from Australia, 3 from the United Kingdom, 2 from Sweden, and one each from Denmark and Germany . Data collection for the studies occurred from 1982 to 2011 .…”

Section: Resultsmentioning

confidence: 99%

“…There are 7 studies set in the United States, 2 from Australia, 3 from the United Kingdom, 2 from Sweden, and one each from Denmark and Germany . Data collection for the studies occurred from 1982 to 2011 . The sample includes at least 84,500 women admitted to a birth center in labor …”

Section: Resultsmentioning

confidence: 99%

“…Data collection for the studies occurred from 1982 to 2011 . The sample includes at least 84,500 women admitted to a birth center in labor …”

Section: Resultsmentioning

confidence: 99%

“…The estimated number of women in the review excludes intent‐to‐treat studies that did not identify the number of women admitted in labor and studies where overlapping data could not be identified . Overlapping data occur when more than one publication uses information from the same data set and time period.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Phillippi¹,

Danhausen²,

Alliman³

et al. 2018

J Midwife Womens Health

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Data collection for the studies occurred from 1982 to 2011 . The sample includes at least 84,500 women admitted to a birth center in labor …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Phillippi¹,

Danhausen²,

Alliman³

et al. 2018

J Midwife Womens Health

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“…The birth center model has been recognized as a high quality alternative to hospitalization for healthy, childbearing women 1, 2, 3, 4, 5. Recently, there has been renewed interest in birth settings and risk appropriate levels of care 6, 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014

Jolles

Langford

Stapleton³

et al. 2017

Birth

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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.

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Birth Center Model of Care

Rathbun¹

2017

JAMA

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In Reply Drs Peacock and Sterz comment that detailed information on cooling method, target temperature, and time to achieved target temperature would provide valuable insights into our findings. These data were not collected because Get With the Guidelines (GWTG)-Resuscitation is not solely a registry for therapeutic hypothermia treatment, but rather collects extensive data (>250 variables) on the totality of in-hospital cardiac arrest care. Although GWTG-Resuscitation has recently introduced a postresuscitation module to collect detailed information on temperature management, this optional module has been adopted by only a few hospitals and has enrolled few patients treated with therapeutic hypothermia. Nonetheless, we assert that cases of ineffective induction of therapeutic hypothermia (ie, not achieving temperature targets <34°C) in the study's hypothermia-treated patients would have biased the results toward the null and should not have resulted in lower survival rates in the hypothermia-treated group. It is possible that overcooling below recommended targets of 32°C (which occurred in approximately 21% of the study's hypothermia-treated patients) could have worsened outcomes in this group. As such, we believe that the observations represent a "real-world" estimate of the delivery and effectiveness of therapeutic hypothermia for patients with in-hospital cardiac arrest in the absence of clinical trials.Dr Bougouin and colleagues raise the possibility that the non-hypothermia-treated patients may have undergone active cooling because their lowest achieved temperature appeared similar to the 36°C group of the TTM trial. In fact, the lowest achieved temperature in the 36°C group of the TTM trial was a mean of 35.3°C, with mean hourly temperatures during the first 24 hours consistently between 35°C and 36°C. 1 In contrast, the lowest achieved temperature in our study's non-hypothermia-treated patients was higher, and we now report that the highest achieved temperature in this group was a mean of 37.4°C (SD, 1.3°C) and a median of 37.4°C (interquartile range, 36.8°C-38.1°C)-far exceeding the TTM trial's maximum 36°C target. Moreover, the TTM trial was not published until December 2013, a year before our study period ended. Given these 2 reasons, the proportion of our study's non-hypothermia-treated patients who were managed with an active cooling strategy with a target temperature below 36°C is likely small.We recognize the limitation of the observational nature of our study and reiterate the need for a randomized clinical trial to confirm the findings. Meanwhile, use of therapeutic hypothermia for patients with in-hospital cardiac arrest may need reconsideration pending evidence documenting clinical benefit.

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Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison

Cited by 20 publications

References 26 publications

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014

Birth Center Model of Care

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