What Are Freestanding Birth Centers?

Are Freestanding Birth Centers Safe?

Another 2013 study published in the American Journal of Obstetrics & Gynecology (AJOG) included an extensive look at Apgar scores in babies born in various birth settings and with certain birth attendants from 2007 to 2010. These settings included:
  • Hospital births attended by a physician
  • Hospital births attended by a midwife
  • Freestanding birth centers attended by a midwife
  • Home births attended by a midwife.
Apgar scores are tests performed on a baby at one and five minutes after birth. The one-minute score helps to determine how well the newborn tolerated the birthing process, and the five-minute score shows how well the baby is doing outside of the womb. The tests involve examining the baby's:
  • Heart rate
  • Muscle tone
  • Breathing
  • Reflexes
  • Skin color.
The study looked at the occurrence of five-minute Apgar scores of 0 and seizures or serious neurological dysfunction in the various birth settings/attendants. An Apgar score of 0 is basically a stillbirth, since it is extremely rare for a baby with a five-minute Apgar score of 0 to live very long. The study used Apgar scores because they are universally recorded for all births.
The data collected was from the United States Centers for Disease Control's National Center for Health Statistics for singleton term births (at least 37 weeks gestation and 5.5 pounds or more). The data was quite extensive, looking at 13,891,274 babies born during this four-year period.
According to this study, although women having home births have a lower risk profile (because high-risk women usually choose hospital births), there is an increased rate of adverse outcomes for home births. Also, for freestanding birth centers, there is an increased risk compared to hospital deliveries, although the risk is lower than for home birth.
Specifically, the medical evidence showed that the relative risk of a five-minute Apgar score of 0 for midwife home deliveries was 10.55 times higher than those for physician-attended hospital births, with 95 percent confidence interval. The relative risk for midwife home deliveries for women who were having their first child increased to 14.24 times higher than physician-attended hospital births. For freestanding birth center midwives, the relative risk was less than home deliveries, but was higher than hospital deliveries by physicians or midwives.
It's interesting to note, however, that the midwife-attended deliveries in the hospital had a lower relative risk than those hospital births attended to by a physician.
The results showed a pattern for the outcomes, with babies born in home settings having a significantly higher risk of a five-minute Apgar score of 0 (as well as neonatal seizures or serious neurological dysfunction) compared with hospital births. Freestanding birth centers had an intermediate risk, in between home births and hospital births.
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