ST. LOUIS - At the Birth and Wellness Center in O’Fallon, Mo., women deliver babies in a low-tech, homelike setting with midwives. Yet it and other birth centers nationwide are being studied as an “innovative” approach to reducing preterm births among the poor.
“We’ve been trying to change how maternity care is delivered for 30 years,” said Kate Bauer, executive director of the American Association of Birth Centers. “But when it’s such a small percentage of women receiving this care, it is still very much innovation.”
Only 0.4 percent of all births take place in birth centers, yet those centers boast impressive health outcomes at a cost far less than hospital births, according to data compiled from over 15,000 birth center deliveries released three years ago.
When it comes to preterm birth, the rate is 3.75 percent among birth centers, compared to 11.4 percent of all births nationwide. Among African-Americans, the rate is even higher: 16.5 percent.
Babies born just a few weeks early are at risk of severe health problems and lifelong disabilities, statistics from the Centers for Disease Control and Prevention and the March of Dimes show. Premature birth is the leading cause of death of children under 5 - and a driving factor behind African-American babies dying at more than twice the rate of Caucasian babies.
With the costly and long-term consequences of preterm birth, the government is taking an interest in birth centers and the midwifery model.
Two years ago the Centers for Medicare and Medicaid Services launched Strong Start. The four-year initiative is studying how different approaches to prenatal care can improve health outcomes and reduce cost among pregnant women and newborns using Medicaid, the federal health care program for the poor.
As part of the initiative, the American Association of Birth Centers was awarded $5.35 million to measure outcomes and costs among its members. The Birth and Wellness Center recently joined more than 40 other birth centers across the country as a study site.
“Participating in the Strong Start program is validating the care that we already provide,” said certified nurse midwife Jessica Henman, director of the center. “We, as an individual practice, and the American Association of Birth Centers want to demonstrate that low-cost, personalized care for women can vastly improve outcomes for mothers and babies.”
About 40 percent of the patients at the Birth and Wellness Center use Medicaid. Nationwide, nearly half of all births are covered by Medicaid. Medicaid patients typically have twice as many adverse health outcomes as others, according to a report by the Medicaid Health Plans of America. Many face food insecurity, chronic unemployment, unstable housing, lack of transportation and low levels of education. Preterm birth alone accounts for 50 percent of all pregnancy costs, largely due to neonatal admissions, the Medicaid plans report found. Just one premature baby costs an extra $12,000.
Since it opened three years ago, the Birth and Wellness Center boasts a preterm birth rate of less than 1 percent and even fewer babies needing intensive care among its approximately 350 births.
Among patients who start labor at the center, only 3 percent end up needing a C-section at a hospital (nationwide birth center rate is 6 percent), while about 27 percent of low-risk hospital patients have surgical births. Four weeks after birth, 100 percent of the birth center’s clients are breast-feeding, Henman said.
Cost savings come from better health outcomes and a reduction in medical interventions that have become routine in hospitals - where studies show that most women receive continuous electronic fetal monitoring and intravenous fluids, and nearly half have their labor accelerated with medications. Most patients are also restricted to bed, not allowed to eat or drink and give birth lying on their backs. Evidence indicates that routine use of these practices, with no medical indication, has little benefit and increases risk for mothers and babies.
The midwifery model focuses on individualized care. The initial prenatal appointment lasts about an hour, and subsequent visits take 30 minutes. Midwives (advance practice nurses) assess nutrition, exercise habits, health history and stress factors in order to treat problems early and prevent complications such as high blood pressure or blood sugar that can require an early delivery. Questions are encouraged at any hour. The Strong Start initiative also pairs birth center patients with a peer counselor who meets with women three times during their pregnancy and provides another layer of support and guidance.” Our whole model is based on education and prevention, not just the treatment of a disorder once it already occurs,” Henman said.
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