Investigation of institutional differences in primary cesarean birth rates

Twelve years and more than 30,000 nurse-midwife-attended births: The Los Angeles County + University of Southern California Women's Hospital birth center experience

“…Lower cesarean birth rates are common among women who are of lower socioeconomic status (16), are of Hispanic ethnicity (17, 18), have no health insurance or are insured by Medicaid (17–19), give birth in a government‐owned hospital (19), or receive nurse‐midwifery care (20). Thus, a largely indigent, Hispanic population receiving care in an inner‐city hospital birth center staffed by nurse‐midwives would be expected to have a low cesarean birth rate.…”

The Experience of Planned Home Birth: Views of the First 500 Women

“…This debate has not subsided in the presence of large population-based studies that have failed to demonstrate excess risk associated with home birth (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Controversy continues, given the absence of randomized controlled trials and inability to draw conclusions from observational studies because outcomes are attributed to actual versus planned place of birth (13)(14)(15), difficulty in ascertainment of qualifications of caregivers (16), nonrepresentative sampling (8,9), lack of an appropriate comparison group (3,9,11), inadequate statistical power (4,10), inability to exclude unplanned home births from the study sample (4,16,17) inability to sort out the effect of place of birth as opposed to the type of caregiver (18,19), and differing qualifications of midwives (lay versus direct entry versus nursemidwives) (4).…”

Use of the nurse-midwifery clinical data set for classification of subjects in birth center research

“…Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are associated with a high degree of safety (1–7) and reduced costs (8–10) as compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number (approximately 125 in the United States in 1993 [National Association of Childbearing Centers]).…”