Oral

In this session we will explore Birth Centers and Midwifery Care and their good outcomes and cost effectiveness. The current level of cesareans, (32.9% in 2009) is unprecedented for the U.S. and has led to growing concerns associated with the impact of repeat cesarean deliveries on both maternal and infant health outcomes. Increasing U.S. prematurity and caesarean section rates are central to rapidly increasing maternity care costs. Epidemiologic research on planned home births with midwives has demonstrated safety for low-risk women, reduced caesarean section rates, and lower prematurity rates. The midwifery-led, collaborative model of maternity care in birth center is a cost-effective model that promotes physiologic birth with an emphasis on evidence-based maternity care. Data from the American Association of Birth Centers' national data registry, the Uniform Data Set, suggests that this model achieves excellent perinatal outcomes with far less use of expensive interventions that appear to increase the risk of adverse outcomes. We conclude that care at a freestanding birth center can be a cost-effective way of improving birth outcomes for low income women.

Session Objectives: 1. Describe recent US trends in vaginal birth after cesarean(VBAC). 2. Compare the maternal outcomes associated with repeat cesareans and VBACs. 3. Identify the risks associated with having three cesarean births. 4. Describe the two imporntant epidemiologic differences in outcomes associated with midwife-attended home birth that impact on cost of care. 5. Describe observed differences in maternal and infant outcomes for a freestanding birth center versus usual care. 6. Assess the cost-savings achieved by a freestanding birth center based on lower rates of cesareans and preterm births 7. Compare key birth center outcomes with national data 8. Describe practices in birth centers that support physiologic labor & birth.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)