Whether low-risk women give birth in collaborative care birth centers that use certified nurse-midwife (CNM)/obstetrician management or in a hospital where care is managed by an obstetrician, maternal and infant outcomes are similar. However, the collaborative care birth centers have fewer surgical deliveries and use fewer medical resources, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07161).
William H. Swartz, M.D., of the University of California, San Diego, Medical School and his colleagues studied the care and outcomes of 2,957 low-risk, low-income women from the time they began prenatal care to discharge home from a collaborative care birth center or hospital. Of these women, 1,801 received collaborative care, and 1,149 received traditional hospital care.
Major antepartum, intrapartum, and neonatal complications were similar in both groups, as were neonatal intensive care unit admissions. However, women in collaborative care had 15 percent more normal spontaneous vaginal deliveries, 23 percent fewer episiotomies, and 36 percent less use of epidural anesthesia.
Overall, more technical interventions (for example, induction and augmentation of labor with oxytocin, episiotomies, and epidural use) were more common in traditional care and less technical interventions (walking, tub or shower use, and oral fluids) were more common in collaborative care.
Also, collaborative care women had shorter lengths of stay in the birth facility, with 28 percent more being discharged before 24 hours, and almost 6 percent fewer having stays longer than 72 hours. Thus, operative deliveries and hospital stays, major determinants of the cost of perinatal care, were substantially reduced with collaborative care. The researchers conclude that managed care organizations, local and State governments, and obstetric providers may want to consider inclusion of collaborative management/birth center programs in their array of covered or offered services.
See "Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care," by Debra J. Jackson, R.N., M.P.H., D.Sc., Janet M. Lang, Ph.D., Sc.D., Dr. Swartz, and others, in the June 2003 American Journal of Public Health 93(6), pp. 999-1006.