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Physician‐Led, Hospital‐Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events
Author(s) -
O'Hara Margaret H.,
Frazier Linda M.,
Stembridge Travis W.,
McKay Robert S.,
Mohr Sandra N.,
Shalat Stuart L.
Publication year - 2013
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12051
Subject(s) - medicine , confidence interval , relative risk , obstetrics , breastfeeding , retrospective cohort study , adverse effect , medical record , vaginal delivery , pregnancy , pediatrics , biology , genetics
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; 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. 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.