title: Physician-led, hospital-linked, birth care centers can decrease cesarean section rates without increasing rates of adverse events.
abstract: BACKGROUND
  This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service.
  
  
  METHODS
  Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998-2005.
  
  
  RESULTS
  Compared with hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk = 0.73, 95% confidence interval 0.59-0.91; p < 0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk = 1.04, 95% confidence interval 0.97-1.13; p = 0.25) and a higher initiation of breastfeeding (adjusted Relative Risk = 1.28, 95% confidence interval 1.25-1.30; p ≤ 0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk = 0.60, 95% confidence interval 0.55-0.66; p < 0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center.
  
  
  CONCLUSIONS
  A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Kansas School of Medicine-Wichita, Wichita, Kansas.
authors.forename: Margaret H
authors.initials: MH
authors.lastname: O'Hara
authors.forename: Linda M
authors.initials: LM
authors.lastname: Frazier
authors.forename: Travis W
authors.initials: TW
authors.lastname: Stembridge
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKay
authors.forename: Sandra N
authors.initials: SN
authors.lastname: Mohr
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Shalat
mesh_terms: D000328:Adult; D016550:Birthing Centers / Q000706:statistics & numerical data*; D001942:Breast Feeding; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: birth care center; delivery; hospital-linked; obstetric; physician; pregnancy outcome