Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014

Abstract

BackgroundVariations in care for pregnant women have been reported to affect pregnancy outcomes.MethodsThis study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio‐behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored.ResultsMedicaid beneficiaries enrolled at AABC sites had diverse socio‐behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low‐risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery‐led prenatal care, and 84% with midwifery‐ attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4‐times greater risk of cesarean birth among medically low‐risk childbearing Medicaid beneficiaries.ConclusionsThe birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.

Trends and state variations in out‐of‐hospital births in the United States, 2004‐2017

“…Ultimately, 2/3 of planned home births and 1/3 of birth center births were self-paid by the mother, compared to only 3% of hospital births. This suggests that, despite successful pilot projects (24), most current payment mechanisms are not structured to support out-of-hospital birth options for a large proportion of women seeking them. This lack of access to payment options for out-of-hospital births may prevent many women from choosing these births.…”

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

“…The AABC birth center model provides enhanced primary maternity care that is integrated into the overall perinatal care system (Figure ). This midwifery‐led model (Figure ) includes structured relationship building, time‐intensive care, and individualized education, all of which have been demonstrated to improve outcomes for socially at‐risk communities …”

“…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 …”

“…Previous birth center study populations were mostly white, non‐Hispanic, college‐educated, and middle‐ and higher‐income mothers, making it difficult to generalize findings to all lower‐risk childbearing mothers in the United States . Preliminary evaluation of American Association of Birth Centers (AABC) Medicaid beneficiaries enrolled at Strong Start sites demonstrated population diversity and high‐quality outcomes responsive to the enhanced, wellness‐oriented model of care …”

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

“…1 Birth center and midwifery-led care have been identified as a perinatal care model with the potential to help improve health outcomes for more women, including those experiencing disparities. [2][3][4][5] The recent publication of the national evaluation of the Strong Start for Mothers and Newborns Initiative revealed a dramatic reduction of preterm, low birth weight, and cesarean births for women participating in birth center care compared with women of similar risk levels in usual care. 6 Yet, there is little policy discussion about these significant findings or planning for wider implementation of birth center and midwifery-led care.…”