title: Midwifery care at a freestanding birth center: a safe and effective alternative to conventional maternity care.
abstract: OBJECTIVE
  To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.
  
  
  METHODS
  Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions.
  
  
  METHODS
  Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care. We match on observable characteristics available on the birth certificate, and we use distance to the birth center as an instrument.
  
  
  METHODS
  Birth certificate data from 2005 to 2008.
  
  
  RESULTS
  Women who receive birth center care are less likely to have a C-section, more likely to carry to term, and are more likely to deliver on a weekend, suggesting less intervention overall. While less consistent, findings also suggest improved infant outcomes.
  
  
  CONCLUSIONS
  For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.
authors.affiliation: The Urban Institute, Washington, DC.
authors.forename: Sarah
authors.initials: S
authors.lastname: Benatar
authors.forename: A Bowen
authors.initials: AB
authors.lastname: Garrett
authors.forename: Embry
authors.initials: E
authors.lastname: Howell
authors.forename: Ashley
authors.initials: A
authors.lastname: Palmer
mesh_terms: D000328:Adult; D001719:Birth Certificates; D016550:Birthing Centers; D002585:Cesarean Section / Q000706:statistics & numerical data; D004219:District of Columbia; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods*; D009774:Obstetrics; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D057216:Propensity Score; D000078329:Workforce
keywords: African American women; Midwives; cesarean section; low-income women; prenatal care