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.