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Birth center delivery safe, less surgery: study

By Jacqueline Stenson

Last Updated: 2003-05-29 10:02:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Women who have their children at a birthing center where midwives and obstetricians team up have more natural deliveries with fewer interventions than women who give birth at a hospital -- and their infants are just as healthy, new findings show.

"In a rigorous scientific way we were able to demonstrate that the outcomes in terms of safety were comparable," said study author Dr. William H. Swartz, a former professor of reproductive medicine at the University of California in San Diego who is now retired.

The findings indicate that birthing centers can provide safe care for women with low-risk pregnancies while also cutting down on procedures and costs, Swartz told Reuters Health.

"These outcomes occurred with far fewer interventions," he said.

At the San Diego birthing center involved in the study, certified nurse-midwives oversee women's deliveries and much of their prenatal care, Swartz explained. Women who develop complications and require a Caesarean section or other advanced care are transferred to the hospital across the street. In some cases, obstetricians or pediatricians may be asked to come to the birthing center to help care for a mother or infant.

In their report in the June issue of the American Journal of Public Health, the researchers describe the birthing center as providing a "homelike, 'low-tech' environment" with an emphasis on emotional support.

The study, conducted from 1994 to 1996, compared 1,808 women at the birthing center to another 1,149 women who gave birth at a hospital with an obstetrician. At the time of study enrollment, all women were considered to be at low risk for complications of pregnancy and delivery.

Results showed that while mothers and babies in both groups had similar rates of complications, women at the birthing center were less likely than the others to have their labor induced (eight percent versus 15 percent) or to undergo a Caesarean section (11 percent versus 19 percent).

They were also less likely to receive epidural anesthesia (30 percent versus 69 percent) or an episiotomy (13 percent versus 38 percent).

During an episiotomy, a doctor makes an incision to widen the vaginal opening, usually in an attempt to prevent major tears during delivery. But the procedure is controversial because many doctors now believe it generally does more harm than good.

Swartz emphasized that while midwives can offer quality care with fewer interventions, having emergency medical backup readily available is critical in case something goes wrong.

Copyright 2002 Reuters