Outcomes, Safety, and Resource Utilization
Objective: We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care.
Methods: We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.
Results: Major antepartum (adjusted risk difference [RD]=-0.5%; 95% confidence interval [CI]=-2.5, 1.5), intrapartum (adjusted RD=0.8%; 95% CI=-2.4, 4.0), and neonatal (adjusted RD=-1.8%; 95% CI=-3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD=-1.3%; 95% CI=-3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD=14.9%; 95% CI=11.5, 18.3) and less use of epidural anesthesia (adjusted RD=-35.7%; 95% CI=-39.5, -31.8).
Conclusions: For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.

The National Birth Center Study and other studies comparing birth center deliveries with traditional hospital deliveries report favorable outcomes and fewer obstetric interventions in the birth center groups. These studies have been considered inconclusive because of concern that women choosing to deliver at a birth center may have been healthier than women seeking traditional perinatal care. In our study we evaluated the safety and resource utilization of a practice model that included collaborative certified nurse-midwife (CNM)/obstetrician management of perinatal care and a freestanding birth center option for delivery. We paid rigorous attention to the initial perinatal risk of all the women in the study.