Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, and the School of Nursing, Vanderbilt University, Nashville, Tennessee.
Obstet Gynecol. 2020 Mar;135(3):696-702. doi: 10.1097/AOG.0000000000003723.
To describe the development, implementation, and evaluation of a collaborative model between a freestanding birth center and a tertiary care medical center.
An interdisciplinary team developed a freestanding accredited birth center in collaboration with a tertiary care medical center in the southeast United States. We performed a retrospective cohort study of all women obtaining care at the birth center and assessed the rate (and 95% CIs) of cesarean delivery, patient transfers, and adverse maternal and neonatal events.
Between January 2017 and December 2018, 1,394 women initiated prenatal care at the birth center. The study cohort consisted of 1,061 women who continued their prenatal care and planned to deliver at the birth center, of whom 358 (34%) were subsequently transferred before admission and 703 (66%) presented to the birth center in labor. Of those, 573 (82%) were subsequently delivered vaginally in the birth center, and 130 (18%) were transferred for hospital birth. Of those admitted to the birth center in labor, 41 ultimately underwent cesarean delivery for an overall cesarean delivery rate of 6% (95% CI 4-8%). Maternal transfers for postpartum hemorrhage occurred in eight patients (1%; 95% CI 1-2%). There were 39 neonatal intensive care admissions (6%; 95% CI 4-8%), eight cases (1%; 95% CI 0.5-2%) of 5-minute Apgar scores less than 7, and two previable neonatal deaths (0.3%; 95% CI 0-1%).
We describe a collaborative model between a freestanding birth center and a tertiary care medical center, which provided women with access to a traditional birth center experience while maintaining access to the specialized care provided by a tertiary care medical center. We believe that the model may facilitate options for maternity care in regional perinatal systems.
描述一家独立分娩中心与一家三级医疗中心之间合作模式的发展、实施和评估。
一个跨学科团队在美国东南部合作建立了一家独立认可的分娩中心，并与一家三级医疗中心合作。我们对在分娩中心接受护理的所有女性进行了回顾性队列研究，并评估了剖宫产率（及其 95%置信区间）、患者转院率和母婴不良事件发生率。
在 2017 年 1 月至 2018 年 12 月期间，共有 1394 名女性在分娩中心接受产前护理。研究队列包括 1061 名继续接受产前护理并计划在分娩中心分娩的女性，其中 358 名（34%）在入院前被转院，703 名（66%）在分娩时到分娩中心就诊。其中，573 名（82%）在分娩中心顺产分娩，130 名（18%）转院进行医院分娩。在分娩中心分娩的患者中，有 41 名最终行剖宫产，总剖宫产率为 6%（95%CI 4-8%）。有 8 名患者（1%；95%CI 1-2%）因产后出血转院。有 39 名新生儿需转入新生儿重症监护病房（6%；95%CI 4-8%），8 名新生儿（1%；95%CI 0.5-2%）出生后 5 分钟的 Apgar 评分低于 7 分，有 2 例极早产儿死亡（0.3%；95%CI 0-1%）。
我们描述了一家独立分娩中心与一家三级医疗中心之间的合作模式，为女性提供了传统分娩中心的体验，同时也能获得三级医疗中心提供的专业护理。我们认为，这种模式可能有助于在区域性围产期系统中为产妇护理提供更多选择。
