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.
Childbearing and Health (ReaCH) Group, Lancashire, United Kingdom.
Denis
D
Walsh
Soo M
SM
Downe
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