1. Potera, Carol


Certified nurse midwives schedule fewer cesareans and inductions.


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Low-risk pregnant women who received prenatal care and delivered their babies at a freestanding birth center in Washington, DC, had birthing outcomes that were at least as good as-and in some cases better than-women who delivered at traditional hospitals. Certified nurse midwives provided medical care at the freestanding center, which operates separately from the hospitals and serves many low-income and minority women.


According to propensity score analysis (one of two analyses performed), women cared for at the center were 30% less likely to deliver before term, 41% less likely to have a cesarean section, 55% less likely to need forceps or have a vacuum delivery, and 23% less likely to need electrical fetal monitoring than women who delivered at hospitals. Weekend deliveries were also more common at the birthing center than at the hospitals, which explains, in part, the lower rate of cesarean sections and suggests a lower rate of induction (in the absence of specific rates). Among women who had previously undergone cesarean section, more delivered vaginally at the birthing center than at the hospitals (26.7% versus 9.4%). Moreover, babies born at the center weighed an average of 79 g more.


The study's lead author, Sarah Benatar, a research associate at the Health Policy Center of the Urban Institute in Washington, DC, told AJN that the study should help "low-risk women... feel more confident that receiving prenatal care and delivery services at a birth center will be safe for them and their infants." -Carol Potera




Benatar S, et al. Health Serv Res. 2013 Apr 16. [Epub ahead of print].