The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017.

Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.

Outcomes of care in birth centers: demonstration of a durable model.

INTRODUCTION: The safety and effectiveness of birth center care have been demonstrated in previous studies, including the National Birth Center Study and the San Diego Birth Center Study. This study examines outcomes of birth center care in the present maternity care environment. METHODS: This was a prospective cohort study of women receiving care in 79 midwifery-led birth centers in 33 US states from 2007 to 2010. Data were entered into the American Association of Birth Centers Uniform Data Set after obtaining informed consent. Analysis was by intention to treat, with descriptive statistics calculated for maternal and neonatal outcomes for all women presenting to birth centers in labor including those requiring transfer to hospital care. RESULTS: Of 15,574 women who planned and were eligible for birth center birth at the onset of labor, 84% gave birth at the birth center. Four percent were transferred to a hospital prior to birth center admission, and 12% were transferred in labor after admission. Regardless of where they gave birth, 93% of women had a spontaneous vaginal birth, 1% an assisted vaginal birth, and 6% a cesarean birth. Of women giving birth in the birth center, 2.4% required transfer postpartum, whereas 2.6% of newborns were transferred after birth. Most transfers were nonemergent, with 1.9% of mothers or newborns requiring emergent transfer during labor or after birth. There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies. DISCUSSION: This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide.

Validation of an online data registry for midwifery practices: a pilot project.

INTRODUCTION: The value of a data registry for research, benchmarking, and quality improvement activities depends on the underlying quality of the data. This pilot study was conducted to design and implement a validation process assessing data quality in the American Association of Birth Centers' online data registry, the Uniform Data Set (UDS). METHODS: Site visits were conducted in 5 midwifery practices attending births in freestanding birth centers and hospitals to compare data from health records with data in the registry. Practices meeting the inclusion criteria and representative of the overall population of midwifery practices contributing data to the UDS were audited. Between 2% and 5% of each practice's total UDS records were randomly selected and then compared with their matched health records for 29 key variables from the 189 variables in the UDS. RESULTS: A total of 3966 variables were reviewed for 152 records. There were 126 records for which complete maternity care was provided; thus, all 4 parts of the UDS were expected. There were 26 records for women who left care during pregnancy; thus, only parts 1 and 2 of the UDS were expected. Quality of the UDS data was evaluated, with the health records serving as the criterion standard, and the 2 sources were found to be consistent for 97.1% of the variables. DISCUSSION: Results from the study suggest that the data registry can provide valid data for use in research describing the process and outcomes of midwifery care and for benchmarking and quality improvement activities.