Sheila Namakula A Commentary

The Pros and Cons of establishing birth centers The idea of birthing centers is based on a maternal health module of care before, during and after giving birth in a homelike environment with the assistance of trained Certified Nurse Midwives or Certified Professional Midwives (CNMs/CPMs). However, even though the settings of these birth centers are meant to be homelike, they are fully equipped to safely handle births and are still part of the hospital system which they have access to in the event of an obstetric emergency. In some cases the birth centers are located right next to a hospital. There are a variety factors that would determine whether or not the idea of birth centers is a feasible bridge between home births and hospital births. The following is a commentary based on a webinar discussion that was moderated by Rachel Breman, from the Ghana Global Alliance of Nursing and Midwifery at John Hopkins University. Interviewed, were Dr. Susan Stapleton and Dr. Cara Osborne who conducted an investigation on birth centers in the United States.

Some Facts and Figures that were presented in the webinar Their findings entitled Outcomes of Care in Birth Centers; Demonstration of a Durable Model, were published in the Journal of Midwifery and Womens health. The study focused on midwifery-led births in 79 centers in 33 states from 2007-2010. Of the over 22,000 women that registered for the study, 15574 women actually used the facilities throughout their pregnancy with 84% giving birth in the centers, 94% being normal vaginal while 6% were cesarean. The 16% that didnt give birth in the centers were transferred for non-emergency reasons. The outcomes of mortality in the study were as follows; No maternal deaths, fetal mortality deaths were low and comparable to low-risk births in hospitals, 0.47 still births per 1000 women and 0.40 newborn deaths per 1000 women. According to the study the demographics of these women were as follows; 77% were NonHispanic white, 80 % were married and 52% had a college education. [Not sure if these numbers will change over time as the idea of birth centers becomes more popular] In regard to the cost factor, federal and state programs funded nearly 1/3 of the birth resulting in a potential cost savings of >$30million. Can this module work outside the United States As part of the discussion was the issue of how and whether this module could be implemented in developing countries and it was concluded that it could if the centers are part of a hospital system. Unfortunately, in developing countries it was found that the limited availability of skilled birth attendants and physicians as well as logistical barriers created challenges in accessing birth center services. Furthermore, the hospitals that are accessible to the majority of the population were found have limited resources and therefore do not offer healthcare services that are up to standard.

Sheila Namakula A Commentary

However, if the issues of limited resources, education and transportation are addressed then birth centers as a module of maternal health care in the developing world could yield positive outcomes. The study did have positive outcomes in to regard to having zero maternal deaths reported. Furthermore, the number of fetal deaths, still births and new born deaths were quite low. It can therefore be suggested that given the extremely high rate of maternal and infant mortality in many developing countries, the birth center module would be worth exploring and implementing in regard to addressing this issue. What isnt clearly is whether it would be a cost effective option in a developing world context but overall still an idea worth considering.

Work Cited GANM: Birth Center Study: Rachel Breman . April 2013 https://connect.johnshopkins.edu/p11xfmwywd9/?launcher=false&fcsContent=true&pbMode=normal