Are independent birth centers safe?
Numerous medical studies have confirmed the safety of birth for low-risk women in independent birth centers. Here is some basic information and findings gleaned from just a few:
*The National Birth Center Study, which was published in the New England Journal of Medicine in December 1989 reported that, out of the 11,814 women at 84 independent birth centers studied, 15.8% of women who begin labor in a freestanding birth center required transfer to an acute care facility, while only 2.4% required emergency transfer. The others were mainly transferred for slow progress or because the woman requested anesthesia. The overall Cesarean section rate was 4.4%. Over 98% of the birthing women were satisfied with their birth experience. There were no maternal deaths. The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births. They concluded that for low-risk women, “birth centers offer a safe and acceptable alternative to hospital confinement.” To read this historic study in its entirety click here.
Rooks, J., et al., “Outcomes of Care in Birth Centers: The National Birth Center Study ”, New England Journal of Medicine, 321 :1804-1811, (December 28), 1989
*A study published in the International Journal of Gynecology and Obstetrics in 1999 concluded that “when birth centers employ thorough risk selection and significant early referral rates to nearby hospitals, there is no evidence of increased maternal or perinatal risk compared to hospital deliveries.” Additionally, while maintaining statistically similar outcomes, it was found that “the birth center group had significantly fewer medical interventions.” This study reached this finding after comparing all the births from 1992-1994 at two independent birth centers to births occurring during the same time period in a local hospital that were selected for inclusion according to the same risk criteria as the birth centers.
von Schwarzenfeld, D. et al., “Perinatal Outcome in Hospital and Birth Center Obstetric Care”, International Journal of Gynecology and Obstetrics, 65(2):149-56, (May), 1999
*A study published in the American Journal of Public Health in 2003 that studied 2,957 low-risk, low-income women: 1,808 receiving collaborative care in birth center setting and 1,149 receiving traditional care in hospital setting. The study concluded that “for low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.” More specifically, results showed that women at the birthing center were less likely than the others to have their labor induced (8 percent versus 15 percent) or to undergo a Caesarean section (11 percent versus 19 percent) or to have an episiotomy cut (13 percent versus 38 percent). This study again showed that the birth center setting resulted in a lowered level of technological intervention while maintaining a level of maternal/infant safety comparable to the hospital setting for low-risk women.
Jackson, D. et al., “ Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared with Traditional Physician-Based Perinatal Care”, American Journal of Public Health, 93(6):999-1006, (June), 2003.
How is pain management handled in an independent birth center?
How one deals with pain in childbirth is a matter of personal choice. Labor is a process that is individual, and it is important to choose options that reflect your individual approach to birth. The best way to do this is to educate yourself before labor. It is also necessary to know your philosophy towards pain in labor before choosing to birth in a birth center because many conventional pain relief methods are not available in this setting.
Operating under the midwifery model of care, birth centers focus on the positive aspects of pain sensations experienced during the labor process. In embracing this approach it is first necessary to understand that pain in birth is unique in that it is not pathological pain, that is it does not signal that anything is wrong in the body rather it is a physiological indication of progress. This approach focuses on the positive role that pain plays in the birth process. For example, pain sensations trigger the brain to release more oxytocin and endorphins, which result in further dilation and natural pain relief respectively. Pain sensations are also recognized for their tendency to guide the mother into activities and positions that naturally aid progress. This respect for the positive role that pain has to play in the birth process coupled with the added risk associated with medical pain relief methods rules them out as an option in the independent birth center environment.
Independent birth centers promote natural methods of pain coping that do not bear the risks associated with medical methods and do not remove the positive feedback provided by sensation. These methods include hands on support from the midwife, nurse, and significant others of the client's choice, counter pressure, massage, hydrotherapy, relaxation techniques, maintaining strength/hydration through promotion of eating and drinking at will and freedom of movement.
