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Physician-Led, Hospital-Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events

Authors

  • Margaret H. O'Hara MD,

    Assistant Professor
    1. Department of Obstetrics and Gynecology, The University of Kansas School of Medicine-Wichita, Wichita, Kansas
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  • Linda M. Frazier MD, MPH,

    Professor
    1. Department of Obstetrics and Gynecology, The University of Kansas School of Medicine-Wichita, Wichita, Kansas
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  • Travis W. Stembridge MD,

    Assistant Professor
    1. Department of Obstetrics and Gynecology, The University of Kansas School of Medicine-Wichita, Wichita, Kansas
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  • Robert S. McKay MD,

    Professor and Chair
    1. Department of Anesthesiology, University of Kansas School of Medicine-Wichita, Wichita, Kansas
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  • Sandra N. Mohr MD, MPH,

    Adjunct Associate Professor
    1. Department of Environmental and Occupational Health, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
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  • Stuart L. Shalat ScD

    Associate Professor, Corresponding author
    1. Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
    • Department of Obstetrics and Gynecology, The University of Kansas School of Medicine-Wichita, Wichita, Kansas
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Address correspondence to Stuart L. Shalat, ScD, Department of Environmental and Occupational Medicine, Robert Wood Johnson Medical School, EOHSI Building, Room 320, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA.

Abstract

Background

This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service.

Methods

Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005.

Results

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; < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97–1.13; = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25–1.30;  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; < 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.

Conclusion

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.

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