Rural resilience: The role of birth centers in the United States

Abstract

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.

Early Perinatal Workforce Adaptations to the COVID-19 Pandemic

“…Addressing inconsistencies in licensing of and reimbursement for out-of-hospital birth would improve preparation for future pandemics. [41][42][43] The lack of system flexibility contributes to this study's finding of increased work hours and increased patient volume among some respondents, and decreased work hours and patient volume among others. Although the reduction in elective services was a temporary change, the furloughing of employees and closing of private practices during the pandemic may reduce both access to care and the size of the workforce over a longer term.…”

Birth Center Breastfeeding Rates

“…Among the studies at AABC sites that matched similar cohorts from national data, breastfeeding rates were significantly higher at AABC sites (Alliman et al, 2019;Jolles et al, 2017). Although not everyone receiving perinatal care at an AABC site birthed at a birth center, the higher Jolles et al, 2017Jolles et al, , 2020Perdion et al, 2013;Thornton et al, 2017). Three studies described data about breastfeeding rates 4 to 6 weeks postpartum (Alliman et al, 2019;Nethery et al, 2021;.…”

Giving birth in rural Arctic Greenland results from an Eastern Greenlandic birth cohort

“…Low intervention rates in labour and birth are also found in other remote settings [ 13 ]. Evidence from Canada demonstrated that rural maternity services may improved population health outcomes more than centralisation of maternity services [ 4 , 49 , 50 ]. Lower rates of preterm birth and low birth weight are found when women are provided with continuity of midwifery care in remote areas [ 8 , 51 ].…”