Outcomes of free-standing, midwife-led birth centers: a structured review.
BACKGROUND
Over the last two decades, childbirth worldwide has been increasingly concentrated in large centralized hospitals, with a parallel trend toward more birth interventions. At the same time in several countries, interest in midwife-led care and free-standing birth centers has steadily increased. The objective of this review is to establish the current evidence base for free-standing, midwife-led birth centers.


METHODS
A structured review, based on Cochrane guidelines, was conducted that included nonrandomized studies. The comparative outcomes measured were rates of normal vaginal birth; cesarean section; intact perineum; episiotomy; transfers; and babies remaining with their mothers.


RESULTS
Of the 5 controlled studies that met the review criteria, all except one was a single site study. Since no study was randomized, meta-analysis was not performed. The included studies all raised quality concerns, and significant heterogeneity was observed among them. For the outcomes measured, every study reported a benefit for women intending to give birth in the free-standing, midwife-led unit.


CONCLUSIONS
The benefits shown for women recruited into the included studies who intended to give birth in a free-standing, midwife-led unit suggest a question about the efficacy of consultant unit care for low-risk women. However, the findings cannot be generalized beyond the individual studies. Good quality controlled studies are needed to investigate these issues in the future.
Walsh
Denis
D
Childbearing and Health (ReaCH) Group, Lancashire, United Kingdom.
Downe
Soo M
SM
D016550:Birthing Centers; D036861:Delivery, Obstetric / Q000379:methods; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008880:Midwifery; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology