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Review Literature

The National Birth Center Study (NBCS) was a large


prospective descriptive study undertaken to establish if birth center
care was safe for the low-risk, healthy childbearing woman. It also
described experiences and outcomes of birth center clients. This
ground-breaking study involved nearly 12,000 women receiving care
in 84 birth centers in 35 states between June of 1985 and December
of 1987. The study was reported in three parts: I--Methodology and
prenatal care and referrals; II--Intrapartum and immediate
postpartum neonatal care; III--Intrapartum and immediate
postpartum and neonatal complications and transfers, postpartum
and neonatal care, outcomes and client satisfaction. The forms used
had 4 parts: 1) Initial risk screening and demographics; 2) prenatal
care, complications, transfers out of care; 3) intrapartum events,
complications and transfers; 4) postpartum events, complications,
transfers and client satisfaction with birth center experience. These
forms were returned to the NBCS research team monthly. Quality
control involved communication with each centers NBCS trained
coordinator by telephone or site visit. Records were examined for
completeness and accuracy when compared with medical records
and study logs. Statistical Package for the Social Sciences (SPSS)
was used to analyze data. The chi-squared test was also applied
when the likelihood that the outcomes may have been by chance.
The outcomes were based on a three tiered level of severity: a
ranking of one being minor and 3 being major with potential life
threatening consequences. The ranking was defined through a
literature review and input from experienced clinicians and the
studys advisory committee. When compared to the general
childbearing community, the birth center clients had healthier
lifestyles, were supported by family and friends, were older than 18,
had a higher ratio of Hispanic clientele, and lower ratio of Afro-
Americans. The birth center client was more likely to start their
prenatal care in the second trimester. There was a 29% transfer rate
for those who initiated prenatal care at the birth center. The most
common reason for transfer prenatally was ineligibility for FBC care
due to medical or obstetric reasons. Inability to afford FBC fees
accounted for 10% of the transfers. The overall transfer rate during
intrapartum care was nearly 16%. Of those women admitted for
intrapartum care and having their babies in the centers nearly 90%
experienced minor or no complications. Four percent experienced
intermediate complications. Six percent had serious complications
during delivery, 97% had no or minor complications; 2.6% had
intermediate complications; 0.2% experienced serious
complications. Newborns having no or minor complications from
birth to discharge were 87%. Newborns experiencing intermediate
complications were 11%. Two percent experienced serious
complications. The maternal complications of an intermediate or
serious nature postpartum were 8%, 0.5% of those were PPH that
required transfer to hospital care. Refer to Table 1 for the type of
complications. There were no maternal deaths reported and 15 fetal
or neonatal deaths. Seven of those deaths were attributed to
congenital anomalies. The other 8 neonatal deaths were from
abruption placenta, meconium aspiration, hyaline membrane
disease, and 1 possible SIDS death at age 1 week. The follow-up
postpartum visits were attended by 83% of the clients. Almost 99%
stated they would recommend birth center care to family or friends,
and 94% stated they would return with subsequent pregnancies.
The study concluded that for the select group of childbearing
women, the birth center provides safe, satisfying alternative to
hospital care; with outcomes that are similar to a like population in
a hospital setting. The reduction in surgical interventions is another
finding.

The NBCS is a comprehensive examination of birth center safety and


client satisfaction. The strength of this study was found in the
numbers of subjects, which may be more representative of a low-
risk population choosing a birth center option on a national scope.
The number of birth centers with their similarities and differences
also contributed to the depth of statistics. The quality control
measures ensured the content validity. Further studies comparing
low-risk populations choosing hospital care and the low-risk birth
center populations will be beneficial to account for any bias of self-
selected birth center clients being generally healthier. The NBCS
provided the first definitive evidence that for a healthy low-risk
population, birth center care provides safe, satisfying alternative to
hospital. The NCBS serves as a point of reference for future studies.
Since the birth center is based on the midwifery model of care, the
contribution to midwifery as safe and satisfying to clients is
substantial. A quality assessment program will be implemented to
track statistics for the birth center monitoring the FBC quality of
care and safety.

Project Goal Impact to be achieved

The impact of this project will be to support and strengthen


families, and ultimately this Barangay, by creating a facility that
respects, values and supports women and their role as a mother.
The greatest impact will be that the strengthened family will
produce resilience in childrens lives, allowing even the most
socially vulnerable child to be able to meet lifes challenges and find
his or her measure of success.