The National Birth Center Study *1Part I—Methodology and prenatal care and referrals

Rooks, Judith P.; Weatherby, Norman L.; Ernst, Eunice K.M.

doi:10.1016/0091-2182(92)90128-p

Cited by 42 publications

(60 citation statements)

References 29 publications

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“…The current study both describes predictors of transfer and examines the predictors adjusted for the effects of other risk factors, expanding on the findings of previous studies that have been mostly descriptive 1–4 . Our analysis indicates that in order to have a low birth center transfer rate, practitioners may choose not to enroll nulliparous women or women with a previous hospital delivery.…”

Section: Discussionmentioning

confidence: 92%

“…Results from previous research indicated that between 45% and 55% of women who enrolled at birth centers for prenatal care actually delivered their infants there 1–4 . Rooks et al in the National Birth Center Study—a landmark descriptive study on the safety of birth center deliveries in a population composed largely of married and highly educated white women—found that “women who were nulliparous and women with high sociodemographic, behavioral/life‐style, and medical/obstetric risk” were more likely to transfer.…”

Section: Introductionmentioning

confidence: 99%

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Transfers Among Women Intending A Birth Center Delivery in the San Diego Birth Center Study

Nguyen

Rothman

Demissie

et al. 2009

J Midwife Womens Health

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Using data from the San Diego Birth Center Study that enrolled underserved women between 1994 and 1996, we examined demographic, sociobehavioral, and medical predictors of hospital transfer in a group of women who intended to deliver at a freestanding birth center. Of the 1808 women, 34.6% transferred to the hospital antenatally and 19.6% transferred during labor, while 45.7% delivered at the birth center. Compared with multiparous women who had never had a cesarean and never had a previous hospital delivery, nulliparous women were 2.0 times more likely (95% confidence interval [CI], 1.4-2.7), multiparous women with a previous cesarean were 2.6 times more likely (95% CI, 1.7-3.8), and women without a previous cesarean but who had a previous hospital delivery were 2.1 times more likely (95% CI, 1.5-3.0) to transfer after adjusting for other predictors of transfer. Nulliparity, cesarean history and having a previous hospital delivery were among the strongest predictors of a hospital transfer even after adjusting for demographic, sociobehavioral, and other medical conditions. Understanding predictors of transfer may assist practitioners, patients, and policy makers in considering the appropriateness of individuals for birth center delivery or to target further education to reduce nonmedical transfers.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Transfers Among Women Intending A Birth Center Delivery in the San Diego Birth Center Study

Nguyen

Rothman

Demissie

et al. 2009

J Midwife Womens Health

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“…Furthermore, no data are missing. Overall, our dataset has unique completeness in comparison to several of the few available controlled studies of FMU care [44,58,81,82] as all eligible women planning to give birth in the FMUs were included and full background data and follow-up on all participants were obtained.…”

Section: Discussionmentioning

confidence: 99%

Freestanding midwifery units versus obstetric units: does the effect of place of birth differ with level of social disadvantage?

2012

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BackgroundSocial inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. We aimed to study whether the effect of birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief among low risk women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage.MethodsThe study was designed as a cohort study with a matched control group. It included 839 low-risk women intending to give birth in an FMU, who were prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat.ResultsWomen intending to give birth in an FMU had a significantly higher likelihood of uncomplicated, spontaneous birth with good outcomes for mother and infant compared to women intending to give birth in an OU. The likelihood of intact perineum, use of upright position for birth and water birth was also higher. No difference was found in perinatal morbidity or third/fourth degree tears, while birth interventions including caesarean section and epidural analgesia were significantly less frequent among women intending to give birth in an FMU. In our sample of healthy low-risk women with spontaneous onset of labour at term after an uncomplicated pregnancy, the positive results of intending to give birth in an FMU as compared to an OU were found to hold for both women with post-secondary education and the potentially vulnerable group of FMU women without post-secondary education. In all cases, women without post-secondary education intending to give birth in an FMU had comparable and, in some respects, more favourable outcomes when compared to women with the same level of education intending to give birth in an OU. In this sample of low-risk women, we found that the effect of intended place on birth outcomes did not differ with women’s level of education.ConclusionFMU care appears to offer important benefits for birthing women with no additional risk to the infant. Both for women with and without post-secondary education, intending to give birth in an FMU significantly increased the likelihood of a spontaneous, uncomplicated birth with good outcomes for mother and infant compared to women intending to give birth in an OU. All women should be provided with adequate information about different care models and supported in making an informed decision about the place of birth.

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“…When complications arise or pharmacological pain relief is requested, referral to an obstetrician/paediatrician is needed. [4][5][6] During birth the community midwife is assisted by a maternity care assistant. This assistant provides care and support for the mother and her baby for up to 8 days after birth, in a birth centre or at home.…”

Section: Open Accessmentioning

confidence: 99%

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

et al. 2017

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ObjectivesTo estimate the cost-effectiveness of a planned birth in a birth centre compared with alternative planned places of birth for low-risk women. In addition, a distinction has been made between different types of locations and integration profiles of birth centres.DesignEconomic evaluation based on a prospective cohort study.Setting21 Dutch birth centres, 46 hospital locations where midwife-led birth was possible and 110 midwifery practices where home birth was possible.Participants3455 low-risk women under the care of a community midwife at the start of labour in the Netherlands within the study period 1 July 2013 to 31 December 2013.Main outcome measuresCosts and health outcomes of birth for different planned places of birth. Healthcare costs were measured from start of labour until 7 days after birth. The health outcomes were assessed by the Optimality Index-NL2015 (OI) and a composite adverse outcomes score.ResultsThe total adjusted mean costs for births planned in a birth centre, in a hospital and at home under the care of a community midwife were €3327, €3330 and €2998, respectively. There was no difference between the score on the OI for women who planned to give birth in a birth centre and that of women who planned to give birth in a hospital. Women who planned to give birth at home had better outcomes on the OI (higher score on the OI).ConclusionsWe found no differences in costs and health outcomes for low-risk women under the care of a community midwife with a planned birth in a birth centre and in a hospital. For nulliparous and multiparous low-risk women, planned birth at home was the most cost-effective option compared with planned birth in a birth centre.

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The National Birth Center Study *1Part I—Methodology and prenatal care and referrals

Cited by 42 publications

References 29 publications

Transfers Among Women Intending A Birth Center Delivery in the San Diego Birth Center Study

Transfers Among Women Intending A Birth Center Delivery in the San Diego Birth Center Study

Freestanding midwifery units versus obstetric units: does the effect of place of birth differ with level of social disadvantage?

Cost-effectiveness of planned birth in a birth centre compared with alternative planned places of birth: results of the Dutch Birth Centre study

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