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Keywords:

  • Midwives;
  • prenatal care;
  • cesarean section;
  • low-income women;
  • African American women

Objective

To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.

Data Sources/Study Setting

Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions.

Study Design

Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care. We match on observable characteristics available on the birth certificate, and we use distance to the birth center as an instrument.

Data Collection/Extraction Methods

Birth certificate data from 2005 to 2008.

Principal Findings

Women who receive birth center care are less likely to have a C-section, more likely to carry to term, and are more likely to deliver on a weekend, suggesting less intervention overall. While less consistent, findings also suggest improved infant outcomes.

Conclusions

For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.