Search

1 | INTRODUCTION The United States has the worst maternal outcomes of any wealthy country, despite spending more per childbirth episode than any other nation in the world. (1,2) Like [...], Objective: To assess key birth outcomes in an alternative maternity care model, midwifery-based birth center care. Data Sources: The American Association of Birth Centers Perinatal Data Registry and birth certificate files, using national data collected from 2009 to 2019. Study Design: This observational cohort study compared key clinical birth outcomes of women at low risk for perinatal complications, comparing those who received care in the midwifery-based birth center model versus hospital-based usual care. Linear regression analysis was used to assess key clinical outcomes in the midwifery-based group as compared with hospital-based usual care. The hospital-based group was selected using nearest neighbor matching, and the primary linear regressions were weighted using propensity score weights (PSWs). The key clinical outcomes considered were cesarean delivery, low birth weight, neonatal intensive care unit admission, breastfeeding, and neonatal death. We performed sensitivity analyses using inverse probability weights and entropy balancing weights. We also assessed the remaining role of omitted variable bias using a bounding methodology. Data Collection: Women aged 16-45 with low-risk pregnancies, defined as a singleton fetus and no record of hypertension or cesarean section, were included. The sample was selected for records that overlapped in each year and state. Counties were included if there were at least 50 midwifery-based birth center births and 300 total births. After matching, the sample size of the birth center cohort was 85,842 and the hospital-based cohort was 261,439. Principal Findings: Women receiving midwifery-based birth center care experienced lower rates of cesarean section (-12.2 percentage points, p < 0.001), low birth weight (-3.2 percentage points, p < 0.001), NICU admission (-5.5 percentage points, p < 0.001), neonatal death (-0.1 percentage points, p < 0.001), and higher rates of breastfeeding (9.3 percentage points, p < 0.001). Conclusions: This analysis supports midwifery-based birth center care as a high-quality model that delivers optimal outcomes for low-risk maternal/newborn dyads. KEYWORDS birth center, community birth, low-risk birth, maternity care models, midwifery-led birth center, propensity score weighting What is known on this topic * The United States has the worst maternal outcomes of any high-income country, and improving the maternity care system is challenging given the divergent needs of those with high-risk versus low-risk pregnancies. * The midwifery-based birth center model of maternity care centers midwifery principles, with birth occurring in a nonmedicalized environment, and evidence from outside the United States supports improved outcomes for low-risk pregnancies. * Research conducted in the United States on this model of maternity care, typically conducted using either birth certificate data or perinatal data registries, has resulted in conflicting results regarding clinical outcomes. What this study adds * This study used robust statistical methods, a perinatal data registry, and birth certificate data to evaluate a national sample of US births managed in the midwifery-based birth center model. * The use of these data sources allowed for evaluation of the full model of midwifery-based birth center care, beyond simply place of birth or birth attendant. * This analysis found that women and their neonates at low risk for perinatal complications who received care in the midwifery-based birth center model experienced improved outcomes.