Why the birth center model?
The need for change in maternity care in the U.S. is well-documented and there is adequate evidence to support the birth center model of care as a viable strategy for change(1). Both the Institute of Medicine and the Transforming Maternity Care Partnership, a group of 100 health care leaders from delivery systems, providers, and consumers to health plans and purchasers, liability insurers and quality experts, have called for exploration of the birth center model of care(2,3). The federal government has shown support for the birth center model of care via inclusion of mandated facility fee payments to birth centers across the United States in the Patient Protection and Affordable Care Act (Section 2301 (S.3590)(4). The Centers for Medicare and Medicaid Services underscored the importance of examining the birth center model as means of providing high-quality care by including birth center care as one of 3 options for enhanced prenatal care under the Strong Start Initiative in 2012(5).
A study published in 2013, which included more than 15,500 women who received care in 79 midwife-led birth centers, found that 6 percent of participants required a cesarean birth compared to nearly 24 percent of similarly low-risk women cared for in a hospital setting(6).
In Arkansas, we have some of the worst maternal and neonatal outcomes in the United States, but we also have a highly engaged local and state leaders who understand the importance of improving those statistics. The Arkansas Payment Improvement Initiative (www.paymentinitiative.org) chose the perinatal episode as one of the initial episodes of care to be reviewed and, in doing so, is making concrete efforts to improve maternity care in our state. In the spirit of thinking globally and acting locally, our first step was to establish a demonstration site in our home community of Northwest Arkansas that is in perfect alignment with the Payment Improvement Initiative.
The Birth Center of Northwest Arkansas provides a new option for maternity care to the families in our community. BCNWA is the first birth center in the state of Arkansas. Women with low-risk pregnancies have had no out-of-hospital alternative to home birth until the establishment of the center. With the 12th highest cesarean rate in the U.S. in 2011, Arkansas has been in need of alternative birth settings that are integrated into the existing medical community and can provide a safe option for low-risk women.
Data from the most recent birth center study confirm that the birth center model of care decreases intervention rates and cost to the system, validating that outpatient maternity care delivered in the birth center is a high-value option that should be more widely available(6).
- Childbirth Connection. United States Maternity Care Facts and Figures: April 2011. Available here. Accessed November 8th, 2012
- Rooks, J., Weatherby, N., Ernst, E., Stapleton, S., Rosen, D., Rosenfield, A. Outcomes of care in birth centers: The National Birth Center Study. New England Journal of Medicine. 1989: 321 (26)1804-11.
- Institute of Medicine (IOM) (2009). Initial National Priorities for Comparative Effectiveness Research. Washington, DC: The National Academies Press. Available here. Accessed October 12, 2011.
- Patient Protection and Affordable Care Act. Section 230, S.3590, 11th Congress, 2nd Session (2010).
- Center for Medicare & Medicaid Services. Strong Start for Mothers and Newborns. June, 2012. Available here. Accessed June 25, 2012.
- Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: demonstration of a durable model. Journal of Midwifery & Womens Health.