Online Program

Comparison of birth center and hospital cesarean rates

Tuesday, November 3, 2015 : 9:30 a.m. - 9:50 a.m.

Patrick Thornton, CNM MSN, College of Nursing Department of Women, Children, & Family Health Science, University of Illinois, Chicago, Chicago, IL
Background One third of all births in the U.S. are cesarean deliveries. Compared with vaginal births, cesareans increase maternal risk of hemorrhage, infection, and complications in subsequent births. Birth centers (BC) report cesarean rates below the national average, but these rates may be attributable to lower-risk BC patients. No multi-center studies have compared U.S. cesarean rates in BC and hospitals accounting for patient risks. Methods We used secondary analysis to compare cesarean rates among women admitted to midwifery care in 79 BC across the country (n=13,036) and women admitted to midwifery care in affiliated hospitals (n=4648) between 2006 and 2011. We included term, vertex, singleton pregnancies in spontaneous labor. We excluded prior cesareans, preexisting hypertension, diabetes, heart, renal or seizure disorder, and compromised or anomalous fetus. Multivariable logistic regression was used to examine the effect of BC on risk of cesarean, adjusted for patient risks, and stratified by parity. Analysis was done on an intent-to-treat basis. Results Cesarean rates for women beginning labor in BC were lower (4.43 %) than in hospitals (6.74%; crude OR=0.64: CI=0.560-0.736). After adjusting for patient risks, admission to BC instead of hospitals was associated with lower odds of cesarean for both primiparas (OR = 0.53; CI = 0.418-0.661) and multiparas (OR=0.4; CI = 0.269-0.585). Conclusions Results suggest that lower rates of cesarean in BC are not be explained by differences in patient risk. BC care may reduce primary cesarean in both primiparas and multiparas. Regulatory and reimbursement policies should facilitate wider availability of BC services.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Provision of health care to the public
Public health or related nursing
Public health or related research

Learning Objectives:
Compare, on an intent to treat basis, the risk of cesarean section if admitted to BC’s versus hospitals at the onset of spontaneous labor.

Keyword(s): Birth Outcomes, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a certified nurse midwife with over 25 years experience in direct maternity care. I am a 3 rd year PhD student working on a dissertation comparing several outcomes of hospitals and birth centers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.