In the Health Affairs article (see post below), one of the strategies recommended to reduce cesarean rates (and thus healthcare costs) is to establish more birth centers which focus on physiologic childbirth for low-risk women. The Health Affairs article comes on the heels of the publication of a large prospective cohort study looking at outcomes at 70 midwifery-led birth centers in 33 states from 2007 to 2010. Most birth centers in the study were freestanding; a few were physically located inside a hospital building, but met AABC (American Association of Birth Centers) standards for autonomy and were separate from the hospital’s acute care obstetric care. Analysis was by intention to treat so that statistics for women requiring transfer to the hospital either before, during or after labor were included.
As with previous studies looking at birth centers, the outcomes were more than impressive. Most importantly, of the 15, 574 women planning and eligible for a birth center birth at the onset of labor, 93% experienced a spontaneous vaginal birth regardless of where they ultimately gave birth, whereas only 6% had a cesarean birth. There were no maternal deaths and both the intrapartum fetal mortality rate and neonatal mortality rates were comparable to those reported in many studies of low-risk women. Since low-risk women make up approximately 85% of the pregnant women in the United States, switching the usual place of birth from the typical hospital model with frequent unnecessary and sometimes harmful interventions to a birth center model could result in savings in the billions of dollars and improved outcomes for mothers and babies. At the very least, we need to learn from the birth center model strategies to promote healthy, safe and physiological birth.