Physician-Led, Hospital-Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events
Article first published online: 18 SEP 2013
© 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.
Volume 40, Issue 3, pages 155–163, September 2013
How to Cite
Birth 40:3 September 2013
- Issue published online: 18 SEP 2013
- Article first published online: 18 SEP 2013
- Manuscript Accepted: 8 JUL 2013
- birth care center;
- pregnancy outcome
This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service.
Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005.
Compared with hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk = 0.73, 95% confidence interval 0.59–0.91; p < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97–1.13; p = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25–1.30; p ≤ 0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk = 0.60, 95% confidence interval 0.55–0.66; p < 0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center.
A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes.