New Government Report Recommends Birth Center Care
The key takeaway from the report. “Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative to similar Medicaid beneficiaries not enrolled in Strong Start. In particular, rates of preterm birth, low birthweight, and cesarean section were lower among Birth Center participants, and costs were more than $2,000 lower per mother-infant pair during birth and the following year. These promising Birth Center results may be useful to state Medicaid programs seeking to improve the health outcomes of their covered populations.” Findings at a Glance
The U.S. maternity care system is failing our mothers and newborns with significant disparities associated with race, poverty and access to quality care. A new report from the Center for Medicare and Medicaid Innovation (CMMI), a branch of the Centers for Medicare & Medicaid Services (CMS), recommends freestanding birth centers as part of the solution to reduce these poor outcomes. Freestanding birth centers, founded in the midwifery model of care, are shown in this report to reduce preterm birth by 26% compared to matched groups of women with usual care. The report demonstrates birth center care has a larger potential impact on the reduction of preterm birth risk than any other recent medical or public health intervention.
The U.S. spends more on healthcare than any other developed country yet our maternal and neonatal outcomes lag behind far behind our counterparts. One in ten births is premature with that rate increasing in recent years, and racial and economic disparities mean that Black babies typically have 1.5 times the risk of prematurity. Add to this the fact that the cost of maternity care is one of our nation’s largest healthcare expenditures and Medicaid funds about half of the births in the U.S. Premature birth alone costs over $26 billion per year. To address these poor outcomes and disparities, CMMI researched innovative prenatal care models that showed promise of improving outcomes and satisfaction among mothers while reducing costs.
The American Association of Birth Centers (AABC) was awarded a multi-year grant (2013-2017) by the federal CMMI to enroll women covered by Medicaid in birth center care at 47 participating birth centers, then monitor carefully how they fared with birth center care. Almost all of the previous studies of birth center care targeted middle income, educated, low-risk women who could choose to go anywhere for their care. Outcomes of this new research have been overwhelmingly good – reduced rates of preterm birth, lower cesarean rates, higher rates of breastfeeding, and higher rates of satisfaction with the care in particular. Before the AABC Strong Start for Mothers and Newborns Initiative, birth center care was considered by many to be an option for low-risk women and infants only.
The CMMI report shows that participants who received prenatal care in a birth center experienced a rate of preterm birth that was 26% less than a matched group of women with similar risk profiles who had usual care. Cesarean births were 17.5% in the Strong Start birth center model compared to 29% for the matched group of women. The overall primary cesarean rate for women in the birth center portion of the study was 8.7%, compared to a national primary cesarean rate of 21.8%, and a low-risk (NTSV) cesarean rate of 13.9% compared to the national rate of 25.7%.
When comparing women and newborns who received birth center care to the usual care matched group, significant cost savings were demonstrated. Using Medicaid claims data for all women in the AABC birth center group, each mother and infant in the birth center care group saved an average of $2,010 to Medicaid during the first year. The birth center model cost includes the cost of all outcomes whether complications occurred or not.
The birth center model demonstrates improved population health, patient experience, and value. According to the report, “Women who participate in Strong Start through birth centers have more positive birth outcomes and improved care processes relative to women in the comparison group who receive care from typical Medicaid providers.” Improved care processes include the appropriate use of technology and interventions. Reduction of barriers and policy development/implementation are needed to quickly increase access to birth center model care for more Medicaid beneficiaries nationwide.