Jolles Diana R, Niemczyk Nancy, Hoehn Velasco Lauren, Wallace Jacqueline, Wright Jennifer, Stapleton Susan, Flynn Cynthia, Pelletier-Butler Paula, Versace Autumn, Marcelle Ebony, Thornton Patrick, Bauer Kate
American Association of Birth Centers, Perkiomenville, Pennsylvania, USA.
Clinical Faculty, Frontier Nursing University, Hyden, Kentucky, USA.
Birth. 2023 Dec;50(4):1045-1056. doi: 10.1111/birt.12745. Epub 2023 Aug 13.
Interest in expanding access to the birth center model is growing. The purpose of this research is to describe birth center staffing models and business characteristics and explore relationships to perinatal outcomes.
This descriptive analysis includes a convenience sample of all 84 birth center sites that participated in the AABC Site Survey and AABC Perinatal Data Registry between 2012 and 2020. Selected independent variables include staffing model (CNM/CM or CPM/LM), legal entity status, birth volume/year, and hours of midwifery call/week. Perinatal outcomes include rates of induction of labor, cesarean birth, exclusive breastfeeding, birthweight in pounds, low APGAR scores, and neonatal intensive care admission.
The birth center model of care is demonstrated to be safe and effective, across a variety of staffing and business models. Outcomes for both CNM/CM and CPM/LM models of care exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding. Within the sample of medically low-risk multiparas, variations in clinical outcomes were correlated with business characteristics of the birth center, specifically annual birth volume. Increased induction of labor and cesarean birth, with decreased success breastfeeding, were present within practices characterized as high volume (>200 births/year). The research demonstrates decreased access to the birth center model of care for Black and Hispanic populations.
Between 2012 and 2020, 84 birth centers across the United States engaged in 90,580 episodes of perinatal care. Continued policy development is necessary to provide risk-appropriate care for populations of healthy, medically low-risk consumers.
扩大分娩中心模式的可及性的关注度正在不断提高。本研究的目的是描述分娩中心的人员配备模式和业务特征，并探索其与围产期结局的关系。
这项描述性分析包括了2012年至2020年间参与美国分娩中心协会（AABC）机构调查和AABC围产期数据登记的所有84个分娩中心机构的便利样本。选定的自变量包括人员配备模式（认证护士助产士/认证助产士或认证专业助产士/执照助产士）、法律实体状态、每年分娩量以及每周助产士值班时长。围产期结局包括引产率、剖宫产率、纯母乳喂养率、出生体重（磅）、低阿氏评分以及新生儿重症监护病房收治率。
事实证明，在各种人员配备和商业模式下，分娩中心护理模式都是安全有效的。认证护士助产士/认证助产士和认证专业助产士/执照助产士护理模式的结局均超过围产期质量的国家基准，引产率、剖宫产率、新生儿重症监护病房收治率低，母乳喂养率高。在医学低风险经产妇样本中，临床结局的差异与分娩中心的业务特征相关，特别是年分娩量。在年分娩量高（>200例/年）的机构中，引产和剖宫产增加，母乳喂养成功率降低。研究表明，黑人和西班牙裔人群获得分娩中心护理模式的机会减少。
2012年至2020年间，美国84个分娩中心进行了90,580例围产期护理。持续的政策制定对于为健康的、医学低风险消费者群体提供风险适宜的护理是必要的。
