If you’ve seen a Babymoon Inn staff member lately, you’ve probably noticed a shirt that reads, “Evidence-based care with a hug. #birthcenters.” As an accredited birth center, we have a long history of providing holistic and personalized care, but also care that is driven by evidence and what research has shown to lead to the best outcomes for parents and babies.
What that research has demonstrated again and again is that for healthy, low-risk people, accredited birth centers tended by midwives are the safest place to have a baby.
But what makes someone low-risk? New research has identified factors to help determine a person’s risk status and help guide them to the choice of birth location that is appropriate for them.
Jeanette McCullough, IBCLC and co-founder of BirthSwell, interviewed one of the researchers, Melissa Cheyney, PhD, CPM , about the results of the study and its implication on maternity care and policy-making.
Cheyney acknowledged that “there is actually very little agreement on what constitutes ‘low-risk” and that the majority of research on risk factors has been limited to a hospital setting, whereas this new study includes nearly 50,000 people seeking planned birth center or home birth.
The study looked at eight risk factors:
- primiparity (having your first baby)
- history of a prior cesarean (with or without a history of also having a vaginal birth)
- multiple pregnancy
- breech presentation
- gestational diabetes
- post-term pregnancy (greater than 42 weeks
- advanced maternal age
- elevated body mass index.
The study compared the risk factors with the following outcomes:
- likelihood of transfer
- cesarean section
- any genital tract trauma
- any postpartum hospitalization for a maternal indication in the first 6 weeks
- low 5-minute Apgar score (<7)
- very low 5-minute Apgar (<4)
- any neonatal hospitalization in the first 6 weeks
- any NICU admission in the first 6 weeks
- combined fetal and neonatal death
The outcomes of Cheyney’s research showed that:
“Older than average mothers (35 years and older), women with an elevated BMI (30 and over) and women who labored after a cesarean who had also had a vaginal birth all had very little additional risk relative to our comparison group… Women who are older, heavier, or who have had a previous C-section and a vaginal birth who have no other complications actually do quite well in the community setting, and we are hopeful that state regulations will be modified to reflect these findings where needed.”
The research also gives insight into the risks of VBAC (vaginal birth after Cesarean) in an out-of-hospital setting.
“Women who labored after a cesarean who had also had at least one vaginal birth had excellent outcomes in the community setting. In fact, their risk was lower than what we found for women having their first baby. However, we also found that clients laboring after a cesarean who have not had a vaginal birth were at higher risk than anticipated. Their outcomes grouped among the highest risk of the subgroups we analyzed, which included breech and preeclampsia. Women laboring after a cesarean without a previous vaginal birth had a risk of fetal or neonatal death that was ten times higher than the low risk comparison group of healthy multiparous women with no risk factors. Their rate of fetal and neonatal death was 10 out of 1000 compared to a less than one out of 1000 among multiparous women with no risk factors.”
“To complicate matters, among women laboring after a cesarean with no prior vaginal birth, the repeat cesarean rate was just over 22%, which is less than our overall national cesarean rate of 32%. This means that 78% of women in this higher risk group had a vaginal birth! Pregnant people with this risk factor who are considering a community birth are forced to navigate a complex balance of risks and benefits associated with laboring after a cesarean in a community setting.”
Navigating through the research to understand the benefits and risks of any birth setting can be a challenge. Have questions? Ask us.
Read the rest of McCullough and Cheyney’s interview
I recently sat down with Stina Sieg to discuss why the struggle birth centers face in getting AHCCCS coverage for our services. Ms. Sieg also interviewed AHCCCS spokesperson Heidi Capriotti. According to AHCCCS:
“We haven’t heard directly from members that that’s their preference,” said AHCCCS spokesperson Heidi Capriotti.
Capriotti explained that if you’re a mom-to-be on AHCCCS and a birthing center experience is something you want, you should definitely contact her agency. But that’s probably not enough.
You’ve got to contact managed care provider – your health-care plan. They’re the ones who set the reimbursement rates. And Capriotti said they’re the ones who ultimately choose whether or not to include birthing centers in their coverage.
“But we are actively working with our managed care providers to explore options to expand the number of birthing centers available to our members,” she said.
If you are a member – do you agree? It’s time to call AHCCCS and let them know that you do want birth center care! Let’s actively work together for the change we want to see.
Read or listen to the entire piece here.
When I first experienced the birth center model of care as a client, I was so focused on the excellent prenatal care and different model for birth that I did not realize “birth center” encompasses so much more. As we explored the model of care in our start-up phase looking at other birth centers, the depth of the community support and access point for the medical system was our goal.
The Business of Being Born recently featured the Health Foundations Birth Center in Minnesota, who has beautifully achieved this “birth center” model of care with the depth of services that have come to define the birth center experience. Amy Johnson-Grass, the birth center’s founder and the current President of the American Association of Birth Centers explains:
We are unique because we are a lot more than just a birth center and midwifery practice. We are truly an integrative practice with a huge spectrum of offerings on-site. We are not only familiar with herbs, homeopathy, nutrition, and counseling, but we are also prescribers. Plus, we have other providers that work with us too, like chiropractors and acupuncturists. We’re a lactation center. We’re an education center with lots of different class offerings. And, we offer quite a few services for women, outside of maternity care, like annual exams, problem visits, and contraception offerings. This continuity of care (even extending to their kids with our Pediatricians!) really allows for us to focus on community building, which is so important because so many of us lack it. So we hold many events to continue and build those connections ranging from larger gatherings like Every Woman Can to smaller retreats, family picnics, and annual Valentine’s Day party…during Christmas we have about 100 kids come through to see Santa!
Read the entire interview and see more photos of the beautiful birth center.
A fascinating case study and exploration of the WHY behind the delay in evidence to implementation in health care. Although the article does not address maternal health care, the philosophy is clear – does this sound familiar?
David Epstein/ProPublica writes:
“Most of my colleagues,” Christoforetti says, “will say: ‘Look, save yourself the headache, just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery. Just do the surgery.’”
The first case study in the article looked at two patients with very different outcomes. Neither one needed a stent. The patient who got one did not survive. The article explains:
Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The entire article contains several case studies and a thorough look at the research. It is a great read! What are your thoughts relating to maternal health care?