title: Maternal Outcomes in Birth Centers: An Integrative Review of the Literature.
abstract: BACKGROUND
  The birth center, a relatively recent innovation in maternity care, is an increasingly popular location of birth. The purpose of this integrative literature review is to assess the research on maternal outcomes from birth center care.
  
  
  METHODS
  Using methods by Whittemore and Knafl, we conducted an integrative review of studies of birth centers published in English since 1980. Twenty-three quantitative sources and 9 qualitative sources describing maternal outcomes of birth center care were reviewed and synthesized.
  
  
  RESULTS
  Outcomes for women receiving birth care were positive. Spontaneous vaginal birth rates and perineal integrity were higher for women beginning care in a birth center compared to women in hospital care. Rates of cesarean birth were also lower for women planning birth center care. Transfer rates are difficult to compare across studies, but antepartum transfer rates ranged from 13% to 27.2%. Intrapartum transfer rates ranged from 11.6% to 37.4%, and from 11.6% to 16.5% in studies published from 2011 to 2013. Nulliparous women had higher rates of transfer than multiparous women. Few severe maternal outcomes and no maternal deaths were reported in any studies. Women were satisfied with the comprehensive, personalized care that they received from birth centers.
  
  
  CONCLUSIONS
  Quantitative studies reviewed included more than 84,300 women. The heterogeneity of the studies and variations of practice limit generalization of findings. However, even with multisite studies enrolling a variety of birth centers and practice changes over time, the consistency of positive outcomes supports this model of care. Policy makers in the United States should consider supporting the birth center model as a means of improving maternal outcomes.
authors.forename: Jill
authors.initials: J
authors.lastname: Alliman
authors.forename: Julia C
authors.initials: JC
authors.lastname: Phillippi
mesh_terms: D016550:Birthing Centers; D036861:Delivery, Obstetric; D005260:Female; D006761:Hospitals; D006801:Humans; D008427:Maternal Health Services; D036801:Parturition; D010360:Patient Transfer; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control
keywords: birth; birthing centers; freestanding; integrative review; midwifery; prenatal care