Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Phillippi, Julia C.; Danhausen, Kathleen; Alliman, Jill; Phillippi, Ruth

doi:10.1111/jmwh.12701

Cited by 13 publications

(14 citation statements)

References 45 publications

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“…36,37 Variables that reliably and validly indicate neonatal health and transition to extrauterine life are currently lacking. 38 Development of such variables is an important area for future research.…”

Section: Discussionmentioning

confidence: 99%

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

Neal

Carlson

Phillippi

et al. 2018

Birth

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Background: The presence of midwives in a health system may affect perinatal outcomes but has been inadequately described in United States settings. Our objective was to compare labor processes and outcomes for low-risk nulliparous women birthing in United States medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk nulliparous women who birthed in interprofessional (n = 7393) or noninterprofessional centers (n = 6982). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to compare outcomes. Results: There was concordance across logistic regression models, the most restrictive and conservative of which were propensity-matched models. With this approach, women at interprofessional medical centers, compared with women at noninterprofessional centers, were 74% less likely to undergo labor induction (risk ratio [RR] 0.26; 95% CI 0.24–0.29) and 75% less likely to have oxytocin augmentation (RR 0.25; 95% CI 0.22–0.29). The cesarean birth rate was 12% lower at interprofessional centers (RR 0.88; 95% CI 0.79–0.98). Adverse neonatal outcomes occurred in only 0.3% of births and were thus too rare to be modeled. Conclusions: The care processes and birth outcomes at interprofessional and noninterprofessional medical centers differed significantly. Nulliparous women receiving care at interprofessional centers were less likely to experience induction, oxytocin augmentation, and cesarean than women at noninterprofessional centers. Labor care and birth outcome differences between interprofessional and noninterprofessional centers may be the result of the presence of midwives and interprofessional collaboration, organizational culture, or both.

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Section: Discussionmentioning

confidence: 99%

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

Neal

Carlson

Phillippi

et al. 2018

Birth

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“…Studies of freestanding birth centers have consistently demonstrated safe, high‐quality care with fewer medical interventions during labor than usual care, while achieving lower cesarean birth rates . Neonatal outcomes have been similar to those of lower‐risk mothers in usual care …”

Section: Introductionmentioning

confidence: 95%

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

Alliman

Stapleton²,

Wright³

et al. 2019

Birth

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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.

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“…Guidelines for obesity that are not data based limit access to midwifery care for women with obesity from vulnerable circumstances, care that has been shown safe, effective, and cost-effective. [11][12][13][14][15] Additionally, overapplication of treatments meant to avoid obesity-related risk may unnecessarily increase risk for iatrogenic complications such as uterine hyperstimulation during augmentation of labor with oxytocin.…”

Section: Discussionmentioning

confidence: 99%

“…The perinatal outcomes of women with obesity receiving antenatal care from physicians and giving birth in hospitals have been documented and analyzed for 30 years. [5][6][7][8] Multiple studies have reported excellent perinatal outcomes for women receiving antenatal care and giving birth in freestanding birth centers; [11][12][13][14][15] however, the outcomes specific to women with obesity receiving care based on midwifery models and giving birth in US freestanding birth centers have not been separately examined. In this study, we compared maternal and neonatal outcomes between woman with normal weights and those with obesity admitted to US birth centers.…”

Section: Introductionmentioning

confidence: 99%

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

Jevitt

Stapleton²,

Deng³

et al. 2020

J Midwife Womens Health

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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.

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Neonatal Outcomes in the Birth Center Setting: A Systematic Review

Cited by 13 publications

References 45 publications

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

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

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

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