Comparison of birth center and hospital cesarean rates

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.