A Collaborative Model of a Community Birth Center and a Tertiary Care Medical Center

Abstract

OBJECTIVE: To describe the development, implementation, and evaluation of a collaborative model between a freestanding birth center and a tertiary care medical center. METHODS: An interdisciplinary team developed a freestanding accredited birth center in collaboration with a tertiary care medical center in the southeast United States. We performed a retrospective cohort study of all women obtaining care at the birth center and assessed the rate (and 95% CIs) of cesarean delivery, patient transfers, and adverse maternal and neonatal events. RESULTS: Between January 2017 and December 2018, 1,394 women initiated prenatal care at the birth center. The study cohort consisted of 1,061 women who continued their prenatal care and planned to deliver at the birth center, of whom 358 (34%) were subsequently transferred before admission and 703 (66%) presented to the birth center in labor. Of those, 573 (82%) were subsequently delivered vaginally in the birth center, and 130 (18%) were transferred for hospital birth. Of those admitted to the birth center in labor, 41 ultimately underwent cesarean delivery for an overall cesarean delivery rate of 6% (95% CI 4–8%). Maternal transfers for postpartum hemorrhage occurred in eight patients (1%; 95% CI 1–2%). There were 39 neonatal intensive care admissions (6%; 95% CI 4–8%), eight cases (1%; 95% CI 0.5–2%) of 5-minute Apgar scores less than 7, and two previable neonatal deaths (0.3%; 95% CI 0–1%). CONCLUSION: We describe a collaborative model between a freestanding birth center and a tertiary care medical center, which provided women with access to a traditional birth center experience while maintaining access to the specialized care provided by a tertiary care medical center. We believe that the model may facilitate options for maternity care in regional perinatal systems.

Strengthening Interprofessional Collaboration to Improve Transfers Between a Freestanding Birth Center and an Academic Medical Center

“…When birth centers are integrated into their larger health care systems, with predetermined pathways for antepartum and intrapartum transfer of care and ongoing communication between clinicians, perinatal outcomes are optimized. 5,[9][10][11][12][13]29,30 As rates of community birth increase, there are many benefits to the formal adoption of a freestanding birth center into a regional perinatal care center, including meeting the needs of childbearing families, enhancing midwifery care along the low-to-moderate risk spectrum, creating unique clinical education opportunities, and triaging specialty and tertiary care services for those who need or desire that level of care.…”

“…The Vanderbilt Birth Center (VBC), which was first described by an interprofessional team in 2020, 29 is an accredited freestanding birth center owned by Vanderbilt University Medical Center (VUMC). VBC is located less than one mile from the VUMC hospital campus; this close proximity is useful when hospital transfer becomes necessary.…”

What Is New in Obstetric Anesthesia: The 2021 Gerard W. Ostheimer Lecture

“…Another operational strategy to improve care quality while not increasing cost includes optimizing relationships between high and low maternal levels of care. In one example, the authors describe developing a partnership between a freestanding birth center and a tertiary-care medical center; 19 18% of birth center labors were transferred for a hospital birth. Birth center admissions had an overall cesarean delivery rate of 6%, while 6% of infants required neonatal intensive care.…”