Birth Outcomes of Women with Obesity Enrolled for Care at Freestanding Birth Centers in the United States

Abstract

Introduction Current US guidelines for the care of women with obesity generalize obesity‐related risks to all women regardless of overall health status and assume that birth will occur in hospitals. Perinatal outcomes for women with obesity in US freestanding birth centers need documentation. Methods Pregnancies recorded in the American Association of Birth Centers Perinatal Data Registry were analyzed (n = 4,455) to form 2 groups of primiparous women (n = 964; 1:1 matching of women with normal body mass indices [BMIs] and women with obese BMIs [>30]), using propensity score matching to address the imbalance of potential confounders. Groups were compared on a range of outcomes. Differences between groups were evaluated using χ2 test for categorical variables and Student's t test for continuous variables. Paired t test and McNemar's test evaluated the differences among the matched pairs. Results The majority of women with obese BMIs experienced uncomplicated perinatal courses and vaginal births. There were no significant differences in antenatal complications, proportion of prolonged pregnancy, prolonged first and second stage labor, rupture of membranes longer than 24 hours, postpartum hemorrhage, or newborn outcomes between women with obese BMIs and normal BMIs. Among all women with intrapartum referrals or transfers (25.3%), the primary indications were prolonged first stage or second stage (55.4%), inadequate pain relief (14.8%), client choice or psychological issue (7.0%), and meconium (5.3%). Primiparous women with obesity who started labor at a birth center had a 30.7% transfer rate and an 11.1% cesarean birth rate. Discussion Women with obese BMIs without medical comorbidity can receive safe and effective midwifery care at freestanding birth centers while anticipating a low risk for cesarean birth. The risks of potential, obesity‐related perinatal complications should be discussed with women when choosing place of birth; however, pregnancy complicated by obesity must be viewed holistically, not simply through the lens of obesity.

Influência do estado nutricional pré-gestacional no desfecho do binômio mãe-bebê: uma revisão sistemática

“…Muitas das complicações gestacionais e neonatais que oneram a saúde pública poderiam ser evitadas ou atenuadas com estratégias clínicas e nutricionais voltadas ao controle de peso de gestantes ou de mulheres que planejam engravidar (IBGE, 2020). Apesar de a obesidade aumentar o risco para várias complicações gestacionais e neonatais, mulheres obesas podem se beneficiar ao buscar uma instituição médica que tenha mais experiência com gestantes obesas, podendo ter o risco de parto cesáreo e de readmissão pós-parto reduzidos (ERICKSEN et al,2020;JEVITT et al, 2021) O tipo de parto ideal para mulheres obesas tem sido alvo de investigação. Tzadikevitch-Geffen et al (2020) demonstraram que quando a mulher obesa opta pelo parto vaginal, há uma chance em cinco de haver necessidade de cesárea intraparto.…”

The birth center model of care: Staffing, business characteristics, and core clinical outcomes

“…Research on health system volume and birth outcomes is mixed, with a preponderance of data suggesting that higher‐volume birth sites have superior outcomes 31–34 . By contrast, research on birth centers has refuted this finding 35–44 . Lower‐volume rural and level II facilities have been shown to achieve high‐quality outcomes 45,46 .…”