Strong Start in birth centers: Socio‐demographic characteristics, care processes, and outcomes for mothers and newborns

Abstract

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.

Next Steps for Transforming Maternity Care: What Strong Start Birth Center Outcomes Tell Us

“…6 Risk factors such as depression, history of intimate partner violence, and food insecurity were present in the birth center care sample at levels similar to or higher than national averages. 6,9,11 Participants were at higher risk of experiencing preterm and low birth weight births due to psychosocial risk factors than in previous national birth center studies. 6,9…”

“…6,9,11 Participants were at higher risk of experiencing preterm and low birth weight births due to psychosocial risk factors than in previous national birth center studies. 6,9…”

“…Along with all the components of usual prenatal care, enhanced care meant longer midwifery visits with health education individualized to client needs, ready referral to needed resources such as housing or food or to other care providers as needed, and ample opportunities for clients to build supportive relationships with their midwives ( Figure 1). 9 Many of these components are considered to be standard with birth center care. 2,4,5 In Strong Start care in birth centers, more attention was paid to assessing and meeting psychosocial needs.…”

“…The Strong Start birth center group compared with the US childbearing population as a whole was equal in racial and ethnic diversity for Hispanic (23.2% vs 23.2%) and American Indian participants (1.1% vs 1.1%) and slightly lower for African American participants (11.9% vs 14.2%) but more similar than in past studies. 4,9,10 To be eligible for Strong Start, participants were required to be Medicaid or Children's Health Insurance Portability (CHIP) beneficiaries. 6 Risk factors such as depression, history of intimate partner violence, and food insecurity were present in the birth center care sample at levels similar to or higher than national averages.…”

Current Resources for Evidence‐Based Practice, September/October 2019

“…A qualitative analysis of interviews of 10 projects in England using peer support during pregnancy highlights disadvantaged women's unwillingness to open up to professionals, but these women felt socially connected, valued, and empowered through the peer support process . That said, data from the Centers for Medicare and Medicaid Strong Start Initiative showed that the midwifery care model delivered through birth centers to women with similar social and behavioral risks as a national sample resulted in a remarkably lower PTB rate (4.42%) and LBW rate (3.28%) . Although there were racial and ethnic disparities in the results, they were much less than the national disparities.…”