Evidence Shows Birth Centers a Safe Option for Birth

The American Association of Birth Centers (AABC) is committed to quality, family-centered, safe maternity care options for birthing people and newborns.  The birth center model is founded on evidence-based standards of care for low-risk pregnant people.[1] Birth centers work together with other providers, facilities, and systems to ensure pregnant people receive the appropriate level of care throughout pregnancy, labor and delivery, and postpartum.  For the integrity of the model, and the safety of the families served, it is imperative not to deviate from the established Standards for Birth Centers. 

While neonatal mortality is a rare event in birth centers, we acknowledge that healthy childbearing people with low medical risk can experience neonatal mortality.  Most importantly, AABC extends our deepest sympathies to the families who have experienced trauma and loss across all birth settings.   According to previous research, the rate of neonatal mortality in birth centers has remained stable throughout the past several decades, and has been demonstrated to be similar to or lower than the rate for similar populations in hospitals (0.23-1.3 per 1000 births).[2,3,4]

The American Association of Birth Centers is the professional organization representing the birth center movement, dating back to 1975.  AABC has maintained a culture of transparency regarding maternal and newborn quality and safety data throughout the past four decades.  As an example of this commitment, the AABC maintains one of the largest prospective perinatal data registries in the United States.  A list of research related to the use of this registry can be found HERE. 

The current state of the science, constituting decades of research regarding the birth center model of care, supports the safety of birth center birth for both mothers and babies.  Most recently, research from the Center for Medicare & Medicaid Innovation’s Strong Start for Mothers and Newborns Initiative demonstrated that consumers receiving care within the Birth Center model of care had better experiences of care, and similar and in some cases superior birth outcomes, while achieving lower costs. [5] The Strong Start researchers used propensity score reweighting to control for medical and social risks, and analyzed both birth certificate and Medicaid claims data to measure the impact of the Birth Center model of care. 

 The topic of neonatal mortality and birth site is not a new area of research.  Previous studies have been challenged by known methodologic flaws.  In 2020, the National Academy of Science (NAS) released a report, Birth Settings in America: Outcomes, Quality, Access and Choice, detailing the complexities of place of birth research including clear descriptions of the multiple limitations to using birth certificate data to capture neonatal mortality.[6]  AABC recommends that further research on this topic be conducted by interprofessional teams including both physicians and midwives, as experts in normal birth.  This research will help families make informed decisions because they can understand the benefits and risks of community birth. 

References

1. American Association of Birth Centers. Standards for Birth Centers. 2017. https://www.birthcenters.org/birth-center-standards
2. Illuzzi, J. L., Stapleton, S. R., & Rathbun, L. (2015). Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009 [letter to the editor]. American Journal of Obstetrics and Gynecology, 212(2), 250. doi:10.1016/j.ajog.2014.10.005
3. Rooks, J. P., Weatherby, N. L., Ernst, E. M., Stapleton, S.R., Rosen, D., & Rosenfield, A. (1989). Outcomes of care in birth centers: The National Birth Center Study. New England Journal of Medicine, 321(26), 1804-11. doi.org/10.1056/NEJM198912283212606
4. Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery & Women’s Health, 58(1), 3-14. doi.org/10.1111/jmwh.12003
5. Dubay, L., Hill, I., Garrett, B., Blavin, F., Johnston, E., Howell, E., Morgan, J., Courtot, B., Benatar, S., & CrossBarnet, C. (2020). Improving birth outcomes and lowering costs for women on Medicaid: Impacts of ‘Strong Start for Mothers and Newborns.’ Health Affairs Journal, 39(6), 1042-1050. doi.org/10.1377/hlthaff.2019.01042
6. National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. Washington, DC: The National Academies Press. doi.org/10.17226/25636