Study shows birth centers are not among the safest places to have a baby
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Neonatal death rates were higher at freestanding birth centers compared with hospitals, according to data from a retrospective cohort study.
The study findings were presented at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting, which is being held virtually.
Based on their study, the researchers said “it is therefore incorrect to state, as ACOG has done, that with respect to the settings of safety measures of neonatal outcomes, that hospitals and accredited birth centers are the safest settings for birth.”
Amos Grünebaum, MD FACOG, a professor of obstetrics and gynecology at Lenox Hill Hospital and Zucker School of Medicine at Hofstra/Northwell, and colleagues analyzed data from the CDC’s WONDER database from 2016 to 2019. They compared the rate of neonatal deaths indicated on birth certificates in four settings: freestanding birth centers (BCs), home births, hospital births by a midwife (HMW) and hospital births by a physician (HP). The study included 9.7 million women — nearly 79% were aged between 20 and 34 years and almost 53% were non-Hispanic white.
The researchers wrote that the overall neonatal death rate was significantly higher at BCs compared with HMW and HP (adjusted OR = 4.44; 95% CI, 2.97-6.64). BCs also saw a significant increase in 5-minute Apgar scores higher than 4 (aOR = 8.39; 95% CI, 7.69-9.17) and higher than 7 (aOR = 2.99; 95% CI, 2.8-3.19) and an increase in neonatal seizures (aOR = 2.06; 95% CI, 1.43-2.98) compared with hospital births.
“We did not expect the findings to be so significant,” Grünebaum told Healio Primary Care.
“This is the largest study to confirm [that] birth centers are not as safe. They are too far from the hospital, they have no capabilities to perform emergency cesareans or other procedures, and the team in a freestanding birth center is not adequately trained, equipped and numbered to perform sufficient care in an emergency.”
He added the findings can help women make “clearer” decisions on where to have their babies and “that the hospital is by far the safest place to have a baby.”
Grünebaum also encouraged hospitals to take a look at the services they offer their pregnant patients.
“We need a better understanding why women want to deliver outside the hospital and address their concerns,” he said. “We need to offer them in the hospital the same choices they have in birth centers so they can safely deliver their babies in the hospital.”
Healio Primary Care reached out to ACOG regarding the study results and its position on the safety of birth centers, but the organization did not respond at the time of publication.