title: Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.
abstract: OBJECTIVE
  In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan.
  
  
  METHODS
  The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis.
  
  
  RESULTS
  The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals.
  
  
  CONCLUSIONS
  This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes.
authors.affiliation: Department of Women's Health and Midwifery, St. Luke's International University, Tokyo, Japan.
authors.forename: Yaeko
authors.initials: Y
authors.lastname: Kataoka
authors.affiliation: Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan.
authors.forename: Yuko
authors.identifier: http://orcid.org/0000-0003-4629-2371
authors.initials: Y
authors.lastname: Masuzawa
authors.affiliation: Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors.forename: Chiho
authors.initials: C
authors.lastname: Kato
authors.affiliation: Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Eto
mesh_terms: D000328:Adult; D001034:Apgar Score; D016550:Birthing Centers; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008880:Midwifery; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014041:Tokyo; D055815:Young Adult
keywords: birthing center; hospital; midwife; newborn; parturition