Resources
Birth Centers Fact Sheet
"Few innovations in health service promote lower cost, greater
availability, and a high degree of satisfaction with a comparable degree of
safety…. Modern birth centers can identify women who are at low risk for
obstetrical complications and care for them in a way that provides these
benefits." ( New England Journal of Medicine, 12/28/89)
What is a Birth Center?
- The birth center is a homelike facility, existing within a health care system
with a program of care designed in the wellness model of pregnancy and birth.
- Birth Centers are guided by principles of prevention, sensitivity, safety,
appropriate medical intervention, and cost effectiveness.
- Birth centers provide family-centered care for healthy women, before, during and
after normal pregnancy, labor and birth.
What is the Birth Center Experience?
- The quality of care in birth centers reported in the "The National Birth
Center Study" reflects the low overall intrapartum and neonatal
mortality rate of 1..3/1000 births; 0.7/1000 if lethal anomalies are
excluded. These rates are comparable to studies of low risk, in-hospital
births. 1
- The cesarean section rate for women receiving care in birth centers
averages 4.4%, approximately one half that in studies of low risk, in-hospital
births. 1
- Birth centers nationally have consistently displayed charges for care for
normal birth that average up to 50% less than regular hospital stays and
30% less than short stays - including practitioner fees. 2, 3
- More than half of birth centers include routine laboratory exams,
childbirth education, home visits, extra office visits, and initial
newborn examinations in their charges.
- Most major health insurers contract with birth centers for reimbursement.
Because charges reflect cost and since the birth center is a single
service unit, there is no opportunity for cost shifting or operating the
birth center as a "loss leader" to other services.
- 98.8 percent of women using the birth center would recommend it to friends
and/or return to the center for a subsequent birth. 1
What are the Potential Benefits to Families?
- The birth center approaches pregnancy and birth as a normal family event
until proven otherwise. The program encourages family involvement and
provides a safe environment for families to experience the social,
emotional, and spiritual renewal inherent in bringing forth new life --
while attending to the possibility that a problem may arise that will
require medical intervention or care in the acute care setting of the
hospital. This is in opposition to the view that pregnancy is an illness
and birth a medical/surgical event that needs to be cured.
- The birth center program of education encourages parents to become
informed and self-reliant; to assume responsibility for their own health
and the health of the family.
- The birth center brings generations together to celebrate new life by
encouraging grandparents and children to participate in the birth center
program.
- Birth centers have demonstrated that they are a viable alternative to
unattended home birth and to costly hospital acute care for almost 30
years. It is now time to mainstream these services.
What Are the Benefits to Business and Industry?
- Birth centers offer business and industry direct savings in the cost of
health benefits. If only 100,00 births were attended in birth centers,
annual savings have been estimated to be up to $314 million. 2, 3
- The birth center program provides a starting base for the wellness and
prevention programs being established in industry.
- The family is the hinge pin of the employee. Industry's support of a
program that encourages family unity, self-determination and responsible
health can only improve employee performance.
- Birth center care encourages childbearing women (who may also be employees)
to be confident in the design of their bodies. Such confidence, in turn,
builds self-esteem and starts the young family off thinking of pregnancy,
birth and family health as wellness, not disease.
- The investment of a nine-month intensive focus on improving family health
by promotion of lifestyle changes in pregnancy can have a significant
ripple effect in the long-term improvement of family health.
How Will It Affect the Hospital Acute Care Service?
- Birth centers have had a major impact on humanizing the acute care
maternity services provided by hospitals. Note the rise in hospital
birthing rooms, in privileges for nurse-midwives, in childbirth education
programs, and in more liberal attitudes about family participation.
- Birth centers are showing that the majority of women can safely proceed
through pregnancy and birth using acute care services only as needed. In a
wellness orientation system for pregnancy and birth, birth centers would
be the managed care gatekeepers for the acute care obstetric newborn
services.
- Birth centers eventually will help to reduce the number of costly hospital
beds and expand primary care services.
- Birth centers will help to reduce the dependency fostered by institutional
confinement and strengthen the family's ability to share
responsibility for maternity care and family health.
- Birth centers will help to develop a system of care based first, on the
needs of the family and second, on the needs of medical education or
product promotion.
How Will It Affect the Obstetricians?
- Birth centers provide an opportunity for obstetricians, who are
primarily trained as surgeons, and family physicians who are
trained to prevent and treat disease, to learn and appreciate the
benefits of time and education intensive, "with woman"
midwifery care.
- Birth centers provide an opportunity for obstetricians to invest in a
service in which they can expand their patient base for their specialty.
- Birth centers offer obstetricians an opportunity to develop teams of
professional care providers that will improve primary care services to
families and better use their specialist skills.
How Is the Quality of Care Assured in Birth Centers?
- Through the promotion of state regulations for licensure (37
states currently license birth centers).
- Through established National Standards (adopted 1985).
- Through a Continuous Quality Improvement Program for Birth Centers (model
program available).
- Through accreditation by the Commission for the Accreditation of Birth
Centers.
How Do Birth Centers Contain Costs?
- By retaining autonomy (control) over birth center operations and program
regardless of ownership (some hospitals own freestanding birth centers).
- By providing "high touch" rather than "high tech"
care, birth centers minimize the overuse of technology.
- By providing a program of primary care that emphasizes education, wellness,
prevention, self-help and self-reliance in family health maintenance.
- By using staff efficiently; staff are only in-house when a mother is in-house.
Since birth centers do not compete with emergency services or hospital
acute care, levels of staff are used efficiently and appropriately.
- By sharing responsibility with the childbearing family for health and
prevention of illness.
- By using existing community services when available (instead of creating
costly duplications) for transport services, social services, medical
consultation, laboratories, etc.
- By using established policies and procedures for screening and transfer of
women with problems to acute care services.
- By using low cost construction that meets safety codes.
REFERENCES
- Rooks, J., et al., "Outcomes of Care in Birth Centers: The National
Birth Center Study", NewEnglandJournal of Medicine, 321:1804-1811,
(December 28), 1989
- Health Insurance Association of America, Source Book of Health
Insurance Data - 1996, 1996, Washington, DC.
- American Association of Birth Centers , AABC 1996 Annual Survey Report of
Birth Center Experience, 1997,
Perkiomenville, PA.
- Rooks, J., et al., "The National Birth Center Study: Part I -
Methodology and Prenatal Care and Referrals", Journal of Nurse-Midwifery,
Vol. 37, No. 4: 222-253, July/August, 1992
- Rooks, J., et al., "The National Birth Center Study: Part II -
Intrapartum and Immediate Postpartum Neonatal Care", Journal of Nurse-Midwifery,
Vol. 37, No. 5: 301-340, September/October, 1992
Rooks, J., et al., "The National Birth Center Study: Part III -
Intrapartum and Immediate Postpartum Neonatal Complications and Transfers,
Postpartum and Neonatal Care, Outcomes and Client Satisfaction",
Journal
of Nurse-Midwifery, Vol. 37, No. 6: 361-397, November/December, 1992