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Physician‐Led, Hospital‐Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events

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This study compares outcomes at a hospital‐linked, physician‐led, birthing center to a traditional hospital labor and delivery service.

Using de‐identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005.

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; < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97–1.13; = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25–1.30;  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; < 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.

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.
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Document Type: Research Article

Publication date: 2013-09-01

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