Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Birthing Centers”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1989

Outcomes of care in birth centers. The National Birth Center Study.

We studied 11,814 women admitted for labor and delivery to 84 free-standing birth centers in the United States and followed their course and that of their infants through delivery or transfer to a hospital and for at least four weeks thereafter. The women were at lower-than-average risk of a poor outcome of pregnancy, according to many but not all of the recognized demographic and behavioral risk factors. Among the women, 70.7 percent had only minor complications or none; 7.9 percent had serious emergency complications during labor and delivery or soon thereafter, such as thick meconium or severe shoulder dystocia. One woman in six (15.8 percent) was transferred to a hospital; 2.4 percent had emergency transfers. Twenty-nine percent of nulliparous women and only 7 percent of parous women were transferred, but the frequency of emergency transfers was the same. The rate of cesarean section was 4.4 percent. There were no maternal deaths. The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births. The rates of infant mortality and low Apgar scores were similar to those reported in large studies of low-risk hospital births. We conclude that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections.

Adolescent↗
PubMedDate not supplied

Transfer rates from freestanding birth centers. A comparison with the National Birth Center Study.

This article reviews retrospective data derived from Sharp The BirthPlace. San Diego for 1993-94 and from the University of California. Irvine, Birthing Center for 1994 and compares these findings to data obtained from the National Birth Center Study (NBCS). The focus of this article is on intrapartum transfer rates from the two freestanding birth centers as a critical clinical indicator. Cause-specific transfer rates were calculated for eight clinical conditions. Data suggest that cause-specific intrapartum transfer rates are influenced by factors such as risk profile of the client population, distance to the referral center and mechanisms of transfer, definitions and diagnostic criteria used, and clinical practice guidelines. Reports from the literature, such as NBCS data, might serve as points of reference, but are likely not appropriate baseline indicators (benchmarks of "best practice") for clinical events, against which individual performance can be measured; rather, these benchmarks should be individually defined, based on characteristics unique to each birth center.

Birthing Centers↗
PubMedDate not supplied

Making the alternative the mainstream. Maintaining a family-centered focus in a large freestanding birth center for low-income women.

The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.

Birthing Centers↗
PubMed1997

Characteristics of current hospital-sponsored and nonhospital birth centers.

OBJECTIVES: (1) To describe contemporary birth centers in terms of the population served, organizational and financial characteristics, services provided, mission and philosophy, and planning and marketing techniques. (2) To compare hospital-sponsored and nonhospital models with regard to the above characteristics. METHOD: Data from the National Survey of Women's Health Centers conducted in 1994 are analyzed using t-tests and chi-square tests. RESULTS: Contemporary birth centers serve a diverse population of women and provide a range of clinical and nonclinical services. Birth centers are both hospital-sponsored and nonhospital, with the former growing at a faster rate. Compared to hospital-sponsored centers, nonhospital centers serve a larger proportion of uninsured women, provide a broader range of clinical services, and are more committed to women-centered care. Centers utilize different marketing methods and are involved in a number of organizational changes to better position themselves in the changing health care environment. CONCLUSIONS: Birth centers offer an attractive option to consumers and are a viable model for delivering women-centered care. Given that all "birth center" facilities do not share the same philosophy and service mix, women need to have some assurance of what a "birth center" will, and will not, provide.

Adult↗
PubMed2001

[Birthing centers: review of the literature].

Birth Centers have been established in many industrialized countries but no facilities of this type are available in France. The aim of this review was to analyze the literature concerning existing Birth Centers in order to compare them with conventional hospitals in terms of efficacy. Nine studies were retained including one prospective study. All underlined an improvement in both maternal and perinatal morbidity and mortality in the low-risk pregnancy group. No conclusion can however be made concerning the harmlessness of establishing Birth Centers in the French healthcare system. The small number of cases in these studies, their heterogenicity and the fact that only one was prospective point out the importance of cautious interpretation. Estimation studies must be conducted in experimental sites before opening Birth Centers in France.

Birthing Centers↗
PubMed1986

Home away from home: the alternative birth center.

Hospital alternative birth centers (ABCs) were established in response to consumer demands for 'family-centered maternity care'. This paper considers the controversy among advocates of different childbirth alternatives, including ABCs, home birth and conventional hospital birth. The expectations and evaluations of a sample of women who chose ABC births are compared to attitudes towards the ABC of women who selected home births or conventional hospital births. Women who choose the ABC and those who select home birth share some critical views of conventional labor and delivery, but not the same overall ideology of childbirth. Women who choose the ABC and women who choose conventional labor and delivery share beliefs in the authority of hospital obstetrics and the expertise of physicians.

Adult↗
PubMed1999

Perinatal outcome in hospital and birth center obstetric care.

OBJECTIVE: Our purpose was to compare birth complications and fetal outcome in hospitals and birth centers. METHOD: We retrospectively compared all 801 deliveries between 1992 and 1994 from two free-standing birth centers against 3271 hospital deliveries in Berlin. The hospital collective was selected according to the same risk criteria of the birth centers. RESULTS: The birth center group had significantly fewer medical interventions, with a similar cesarean section rate (3.0% vs. 4.6%, P = 0.057) and occurrence of severe perineal lesions. The episiotomy rate was significantly higher (P < 0.001) in the clinics for first-time and multiple births. The perinatal mortality was not significantly different ( < 0.1 per 1000). One-minute Apgar scores less than 7 were found significantly more often in the birth center group. CONCLUSION: When birth centers employ thorough risk selection and significant early referral rates to nearby hospitals, there is no evidence of increased maternal or perinatal risk compared to hospital deliveries.

Birthing Centers↗
PubMed1995

Development and experience of a university-based, freestanding birthing center.

OBJECTIVE: To describe our experience with a freestanding birthing center established in conjunction with a university medical center, and to determine the safety and effectiveness of such a program. METHODS: The University of California Irvine Medical Center opened a freestanding birthing center 2 miles from the hospital. The unit provides prenatal, labor, delivery, postpartum and well-baby care 24 hours/day. All direct patient care is provided by certified nurse-midwives. Data were collected prospectively to provide a descriptive account and to evaluate maternal and perinatal morbidity and mortality to determine the safety and efficacy of this approach. RESULTS: During the first 20 months of operation, the University of California Irvine Birthing Center cared for 1830 patients. Approximately 90% were indigent, 85% were Hispanic, and 35% were nulliparas. Of the total patients, 12% were transferred antenatally for high-risk conditions and 19% were transferred intrapartum. The cesarean rate for all patients was 10% (6.5% for those whose intrapartum care began at the birthing center). The perinatal mortality rate was six per 1000. Neonatal morbidity rates, neonatal intensive care unit admissions, and maternal complications were not greater than expected. CONCLUSION: The first 20 months of experience with a university-based, freestanding birthing center suggests that this alternative is safe for delivering obstetric and newborn care to low-risk patients.

Adolescent↗
PubMedDate not supplied

Use of the nurse-midwifery clinical data set for classification of subjects in birth center research.

Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are safe and have reduced costs for delivery of low-risk women compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number. Potential inequality of birth center and hospital subjects as to perinatal risk is cited as the major methodologic flaw in the current research on birth centers. Defining an appropriate comparison group is arguably the most important methodologic issue encountered in these investigations. Defining women as "low risk" according to standard perinatal risk tools is not an adequate measure of comparability, as these criteria are generally not equivalent to those defining birth center eligibility. The key is to identify groups for comparison that, at baseline, would be expected to have similar outcomes. To address this concern, a tool based on the American College of Nurse-Midwives' Nurse-Midwifery Clinical Data Set was developed to identify valid comparison subjects for birth center research. This tool focuses on birth center eligibility as opposed to traditionally defined risk. This article reviews the issues of population comparability in birth center research and presents the results of a validation study using this newly developed tool.

Birthing Centers↗
PubMed2001

[For or against birthing centers: a survey of practitioners in the Isere area].

A questionnaire survey on the Birth Centers project was conducted among gynecology and obstetrics healthcare workers in the Isere area. The aim was to better understand the organization of the healthcare system operating around childbirth and to gather suggestions and criticisms concerning this project. Among the 451 people questioned, 42% answered, including 72.6% midwives and 21% physicians. The study was conducted in three phases: exploratory talks with practitioners, drafting the 37-iem questionnaire, and analysis of the answers around nine themes: health worker's information about Birth Centers, awareness of these structures, practice of birth preparation, advice given about practical aspects of Birth Centers, midwife skills, health workers satisfaction concerning the organization of the childbirth healthcare system, ways to improve management of birth in France, healthcare workers opinion about the project and social determinants. Healthcare workers were found to be poorly informed (only 20% were aware of Birth Centers). There was also a high rate of dissatisfaction concerning the current childbirth healthcare system (78%). Most of the responders (38 to 88%) agreed with the underlying principle of Birth Centers (no induction of delivery, early discharge with home care, better information about epidural anesthesia, choice of position during labor and childbirth...), but many discrepancies were found concerning discontinuous fetal monitoring during labor and lack of epidural anesthesia in Birth Centers. Eighty percent accepted the project, but 20% though that one or several physicians should be available in the Birth Center and 47% considered the project would not affect maternal and perinatal mortality/morbidity. This constitutes a bias concerning the health workers' approval of the project. As a result, before thinking about the installation of Birth Centers in France, it would be important to evaluate the project at experimental sites and provide sufficient information to gynecology and obstetrics healthcare workers. This information must concern midwife skills and the mission of birth Centers.

Attitude of Health Personnel↗
PubMedDate not supplied

In-hospital care for low-risk childbirth. Comparison with results from the National Birth Center Study.

The largest prospective study of freestanding birth centers was reported in 1989. This article reports on data from a comparison group of over 2,000 low-risk women who were admitted to hospital-care settings during the same period. The data on the hospitalized women were collected using the research methodology and data collection instruments developed for the birth center study. Consequently, these data offer the opportunity to observe differences that can be associated with birth site. Both groups of women experienced similar rates of serious antepartum and intrapartum health problems and maternal morbidity. However, even when controlling for complications and differences in sociodemographic characteristics, women in hospitals were more likely to receive an interventive style of labor and birth management. Neonatal outcomes were also similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage for women at lowest risk, and it was associated with increased intervention. The results of this study provide support for the National Birth Center Study's conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.

Adolescent↗
PubMed1997

A randomized controlled study of birth center care versus standard maternity care: effects on women's health.

BACKGROUND: The safety of birth center care for low-risk women is an important issue, but it has not yet been studied in randomized controlled trials. Our purpose was to evaluate the effect of birth center care on women's health during pregnancy, birth, and 2 months postpartum by comparing the outcomes with those of women experiencing standard maternity care in the greater Stockholm area. METHODS: Of 1860 women, 928 were randomly allocated to birth center care and 932 to standard antenatal, intrapartum, and postpartum care. Information about medical procedures and health outcomes was collected from clinical records, and a questionnaire was mailed to women 2 months after the birth. Analysis was by "intention to treat;" that is, all antenatal, intrapartum, and postpartum transfers were included in the birth center group. RESULTS: During pregnancy, birth center women made fewer visits to midwives and doctors, experienced fewer tests, and reported fewer health problems. No statistical difference occurred in hospital admissions (4.8%) compared with the control group (4.7%). During labor, birth center women used more alternative birth positions, had longer labors, and did not differ in perineal lacerations. In both groups 1.7 percent of women developed complications, requiring more than 7 days of hospital care after the birth. During the first 2 postpartum months, about 20 percent of women in both groups saw a doctor for similar types of health problems, and no statistical difference occurred in hospital readmissions, 1.4 and 0.8 percent in the birth center and control groups, respectively. CONCLUSION: The results suggest that birth center care is effective in identifying significant maternal complications and as safe for women as standard maternity care.

Adult↗
PubMed1985

A comparative analysis of newborn outcome in a hospital-based birthing center.

Medical records of babies born in a hospital-based birthing center were reviewed to determine whether a birthing center alternative to traditional hospital care of the newborn is safe and cost-effective. A cohort of 123 hospital-based birthing center low-risk deliveries was compared to 100 control low-risk deliveries born in the traditional setting at the medical center during the same time period. Morbidity was assessed using the Hollister Classification as reference and was based on treatment need. The analysis of the babies' status at birth, 24 hours, and 72 hours revealed no difference in immediate morbidity. Cost of hospitalization was reduced by $340.00 per cohort baby. These data suggest that this alternative can be safe and cost-effective. This study applies only to hospital-based birthing centers, because the safety of free-standing birthing centers has not been established and because screening for low risk can not eliminate morbidity.

Adult↗
PubMed1996

Midwifery, birth centers, and health care reform.

Midwifery and birth centers are placed within a concept of social structuring of difference between dominant and subordinate groups and their resultant inequality. Midwifery, and the birth center as a place for the practice of midwifery, present a philosophical view of childbirth that is different from the existing medical and acute care view and rooted in the education and socialization of the respective practitioners. In exercising freedom to act on that philosophical view, nurse-midwives and the physicians and nurses with whom they practice in birth centers are well positioned to be included in the reform efforts to devise a system for improving access to affordable quality health care.

Birthing Centers↗