Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care.
OBJECTIVE
We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care.


METHODS
We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.


RESULTS
Major antepartum (adjusted risk difference [RD] = -0.5%; 95% confidence interval [CI] = -2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = -2.4, 4.0), and neonatal (adjusted RD = -1.8%; 95% CI = -3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = -1.3%; 95% CI = -3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = -35.7%; 95% CI = -39.5, -31.8).


CONCLUSIONS
For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.
Jackson
Debra J
DJ
The BirthPlace Research Department, San Diego, Calif., USA. bessrfam@iafrica.com
Lang
Janet M
JM
Swartz
William H
WH
Ganiats
Theodore G
TG
Fullerton
Judith
J
Ecker
Jeffrey
J
Nguyen
Uyensa
U
D000328:Adult; D016550:Birthing Centers / Q000458:organization & administration* / Q000592:standards; D002140:California / Q000453:epidemiology; D019090:Case Management; D015331:Cohort Studies; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D017146:Models, Organizational; D009721:Nurse Midwives / Q000458:organization & administration* / Q000592:standards; D009774:Obstetrics / Q000458:organization & administration* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D019555:Physician-Nurse Relations; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care / Q000458:organization & administration* / Q000592:standards; D011446:Prospective Studies