Resources
Generations Library Articles
Generations LibraryArticles
- Results of the national study of vaginal birth after cesarean in birth centers. 2004 Nov
- Midwifery, birth centers, and health care reform. 1996 Jun
- "Health care reform as an ongoing process. 1994 Feb
- The National Birth Center Study. Part III--Intrapartum and immediate postpartum and neonatal complications and transfers, postpartum and neonatal care, outcomes, and client satisfaction. 1992 Nov
- The National Birth Center Study. Part II--Intrapartum and immediate postpartum and neonatal care. 1992 Sep
- The National Birth Center Study. Part I--Methodology and prenatal care and referrals.1992 Jul
- Outcomes of care in birth centers. The National Birth Center Study. 1989 Dec
Results of the national study of vaginal birth after cesarean in birth centers.
Lieberman E, Ernst EK, Rooks JP, Stapleton S, Flamm B.
Obstet Gynecol. 2004 Nov;104(5 Pt 1):933-42
OBJECTIVE: Some women wish to avoid a repeat cesarean delivery and believe that a midwife-supported vaginal birth after cesarean (VBAC) in a nonhospital setting represents their best chance to do so; there is a small, persistent demand for out-of-hospital VBACs. We conducted a study to obtain the data necessary to formulate an evidence-based policy on this practice. METHODS: We prospectively collected data on pregnancy outcomes of 1,913 women intending to attempt VBACs in 41 participating birth centers between 1990 and 2000. RESULTS: A total of 1,453 of the 1,913 women presented to the birth center in labor. Twenty-four percent of them were transferred to hospitals during labor; 87% of these had vaginal births. There were 6 uterine ruptures (0.4%), 1 hysterectomy (0.1%), 15 infants with 5-minute Apgar scores less than 7 (1.0%), and 7 fetal/neonatal deaths (0.5%). Most fetal deaths (5/7) occurred in women who did not have uterine ruptures. Half of uterine ruptures and 57% of perinatal deaths involved the 10% of women with more than 1 previous cesarean delivery or who had reached a gestational age of 42 weeks. Rates of uterine rupture and fetal/neonatal death were 0.2% each in women with neither of these risks. CONCLUSION: Despite a high rate of vaginal births and few uterine ruptures among women attempting VBACs in birth centers, a cesarean-scarred uterus was associated with increases in complications that require hospital management. Therefore, birth centers should refer women who have undergone previous cesarean deliveries to hospitals for delivery. Hospitals should increase access to in-hospital care provided by midwife/obstetrician teams during VBACs.
The full article is available for a fee at http://www.greenjournal.org/cgi/reprint/104/5/933
Midwifery, birth centers, and health care reform.
Ernst EK.
Obstet Gynecol Neonatal Nurs. 1996 Jun;25(5):433-9.
Midwifery and birth centers are placed within a concept of social structuring of difference between dominant and subordinate groups and their resultant inequality. Midwifery, and the birth center as a place for the practice of midwifery, present a philosophical view of childbirth that is different from the existing medical and acute care view and rooted in the education and socialization of the respective practitioners. In exercising freedom to act on that philosophical view, nurse-midwives and the physicians and nurses with whom they practice in birth centers are well positioned to be included in the reform efforts to devise a system for improving access to affordable quality health care.
The full article is available from JOGNN
Health care reform as an ongoing process.
Ernst EK.
J Obstet Gynecol Neonatal Nurs. 1994 Feb;23(2):129-38.
Reform in maternal and infant health care is presented as an ongoing process. Three phases of reform occurring during the past 4 decades that have been initiated or involved nurses are discussed: the childbirth education movement, which signalled the beginning efforts of parents to regain responsibility and control of their birth experience; the acceptance of nurse-midwives as primary care providers working in concert with obstetrical specialists; and the free-standing birth center as a holistic environment for the practice of midwifery and the care of women anticipating a medically uncomplicated childbirth experience. These reforms represent a paradigm shift that fits all current proposals for reform of the health care system.
The full article is available from JOGNN
Outcomes of care in birth centers. The National Birth Center Study.
Rooks JP, Weatherby NL, Ernst EK, Stapleton S, Rosen D, Rosenfield A.
N Engl J Med. 1989 Dec 28;321(26):1804-11.
We studied 11,814 women admitted for labor and delivery to 84 free-standing birth centers in the United States and followed their course and that of their infants through delivery or transfer to a hospital and for at least four weeks thereafter. The women were at lower-than-average risk of a poor outcome of pregnancy, according to many but not all of the recognized demographic and behavioral risk factors. Among the women, 70.7 percent had only minor complications or none; 7.9 percent had serious emergency complications during labor and delivery or soon thereafter, such as thick meconium or severe shoulder dystocia. One woman in six (15.8 percent) was transferred to a hospital; 2.4 percent had emergency transfers. Twenty-nine percent of nulliparous women and only 7 percent of parous women were transferred, but the frequency of emergency transfers was the same. The rate of cesarean section was 4.4 percent. There were no maternal deaths. The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births. The rates of infant mortality and low Apgar scores were similar to those reported in large studies of low-risk hospital births. We conclude that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections.
The full article is available from the AABC bookstore.
The National Birth Center Study. Part I--Methodology and prenatal care and referrals.
Rooks JP, Weatherby NL, Ernst EK.
J Nurse Midwifery. 1992 Jul-Aug;37(4):222-53
This is the first of three articles that will report on the complete findings from the National Birth Center Study (NBCS). This article describes the study methodology, compares the entire group of NBCS subjects with all women who gave birth in the United States in 1986, describes the prenatal care and prenatal referral practices of birth centers in the study, and describes the women who were admitted to the birth centers for intrapartum care with regard to characteristics known or thought to be associated with perinatal risk. Nearly 18,000 women were included in the study; two-thirds of them (n = 11,814) were admitted to the birth centers for intrapartum care. Although medical and obstetric complications were the most common reason for discontinuing birth center care, they accounted for less than half of the women who were not admitted to the birth centers for labor and delivery; many women left for a variety of other reasons. In addition to describing birth center clients, birth center care providers, and birth center care, the NBCS provides detailed information about the characteristics and experiences during pregnancy of a large population of essentially low-risk women receiving a low-intervention style of maternity care.
The National Birth Center Study. Part II--Intrapartum and immediate postpartum and neonatal care.
Rooks JP, Weatherby NL, Ernst EK.
J Nurse Midwifery. 1992 Sep-Oct;37(5):301-30.
Part II of a three-part report of the National Birth Center Study describes care provided to 11,814 women and their newborns during and after labor and delivery until they were transferred or discharged from the birth centers. There were few low birth weight or preterm or postterm births, but more macrosomic babies than among all U.S. births during the same time period. Certified nurse-midwives provided most of the intrapartum care, which is described in the context of medically recommended standards and data that describe care provided to low-risk women giving birth in U.S. hospitals. Birth center care deviated from typical hospital care in several ways. Birth center clients were much less likely to receive central nervous system depressants, anesthesia, continuous electronic fetal monitoring, induction and/or augmentation of labor, intravenous infusions, amniotomies, or episiotomies, and they had relatively few vaginal examinations. They were more likely to eat solid food during labor and to take showers and/or baths. Nulliparity was strongly associated with longer first stage labors and longer labor was associated with more frequent use of many kinds of interventions. Infant birth weight, mother's position during delivery, and forceps- or vacuum-assisted deliveries are examined in relation to episiotomies and lacerations and tears.
The National Birth Center Study. Part III--Intrapartum and immediate postpartum and neonatal complications and transfers, postpartum and neonatal care, outcomes, and client satisfaction.
Rooks JP, Weatherby NL, Ernst EK.
J Nurse Midwifery. 1992 Nov-Dec;37(6):361-97.
This is the final article of the three-part report of the National Birth Center Study. Eight percent of the mothers or infants had serious complications; 16% were transferred, 12% before and 4% after the deliveries. Fifteen percent of transfers were emergencies. Nulliparous women were much more likely than parous women to experience dystocia, be transferred, or have cesarean sections. Seventy-five percent of the nulliparous women gave birth in the centers, compared with 95% of the parous women. Eighty-four percent of the women had at least one postpartum home or office visit. There were 11,814 mothers, no maternal deaths, and 15 intrapartum/neonatal deaths (1.3/1,000 births, 0.7 excluding congenital anomalies). Postterm deliveries with macrosomic infants, placental abruption, sustained fetal distress, and thick meconium were associated with high mortality. Mortality was very low for those not transferred and much lower for transfers during labor as compared with those after the delivery. Women with no medical/obstetric risk factors had the lowest rates of transfers and serious complications. Except for postterm pregnancies, the intrapartum/neonatal mortality rate for birth center clients was not higher than rates from studies of low-risk hospital births, and the cesarean section rate was lower. There is no evidence that hospitals are a safer place for low-risk births.