Transfers Among Women Intending A Birth Center Delivery in the San Diego Birth Center Study

Authors

  • Uyen-Sa D. T. Nguyen DSc, MPH,

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    • Uyen-Sa D. T. Nguyen, DSc, MPH, is a Postdoctoral Fellow at Hebrew SeniorLife Institute for Aging Research, Boston, MA.

  • Kenneth J. Rothman DrPH,

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    • Kenneth J. Rothman, DrPH, is Vice President of Epidemiology Research at RTI Health Solutions, Research Triangle Park, NC, and Professor in the Department of Epidemiology at Boston University School of Public Health, Boston, MA.

  • Serkalem Demissie PhD, MPH,

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    • Serkalem Demissie, PhD, MPH, is an assistant professor in the Department of Biostatistics at Boston University School of Public Health, Boston, MA.

  • Debra J. Jackson DSc, MPH, RNC, BSN,

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    • Debra J. Jackson, DSc, MPH, RNC, BSN, is an associate professor at the University of the Western Cape School of Public Health, Cape Town, South Africa.

  • Janet M. Lang ScD, PhD,

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    • Janet M. Lang, ScD, PhD, is an adjunct associate professor of international relations at Watson Institute, Brown University, Providence, RI.

  • Jeffrey L. Ecker MD

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    • Jeffrey L. Ecker, MD, is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, Boston, MA.


Uyen-Sa D. T. Nguyen, DSc, MPH, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St., Boston, MA 021311097. E-mail: Uyen-SaNguyen@hrca.harvard.edu

Abstract

Using data from the San Diego Birth Center Study that enrolled underserved women between 1994 and 1996, we examined demographic, sociobehavioral, and medical predictors of hospital transfer in a group of women who intended to deliver at a freestanding birth center. Of the 1808 women, 34.6% transferred to the hospital antenatally and 19.6% transferred during labor, while 45.7% delivered at the birth center. Compared with multiparous women who had never had a cesarean and never had a previous hospital delivery, nulliparous women were 2.0 times more likely (95% confidence interval [CI], 1.4–2.7), multiparous women with a previous cesarean were 2.6 times more likely (95% CI, 1.7–3.8), and women without a previous cesarean but who had a previous hospital delivery were 2.1 times more likely (95% CI, 1.5–3.0) to transfer after adjusting for other predictors of transfer. Nulliparity, cesarean history and having a previous hospital delivery were among the strongest predictors of a hospital transfer even after adjusting for demographic, sociobehavioral, and other medical conditions. Understanding predictors of transfer may assist practitioners, patients, and policy makers in considering the appropriateness of individuals for birth center delivery or to target further education to reduce nonmedical transfers.

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