LOUIS — At the Birth and Wellness Center in O’Fallon, Mo.,
women deliver babies in a low-tech, homelike setting with
midwives. Yet it and other birth centers nationwide are being
studied as an "innovative" approach to reducing
preterm births among the poor.
been trying to change how maternity care is delivered for 30
years," said Kate Bauer, executive director of the
American Association of Birth Centers. "But when it’s
such a small percentage of women receiving this care, it is
still very much innovation."
percent of all births take place in birth centers, yet those
centers boast impressive health outcomes at a cost far less
than hospital births, according to data compiled from over
15,000 birth center deliveries released three years ago.
comes to preterm birth, the rate is 3.75 percent among birth
centers, compared to 11.4 percent of all births nationwide.
Among African-Americans, the rate is even higher: 16.5
born just a few weeks early are at risk of severe health
problems and lifelong disabilities, statistics from the
Centers for Disease Control and Prevention and the March of
Dimes show. Premature birth is the leading cause of death of
children under 5 — and a driving factor behind
African-American babies dying at more than twice the rate of
costly and long-term consequences of preterm birth, the
government is taking an interest in birth centers and the
years ago the Centers for Medicare and Medicaid Services
launched Strong Start. The four-year initiative is studying
how different approaches to prenatal care can improve health
outcomes and reduce cost among pregnant women and newborns
using Medicaid, the federal health care program for the poor.
of the initiative, the American Association of Birth Centers
was awarded $5.35 million to measure outcomes and costs among
its members. The Birth and Wellness Center recently joined
more than 40 other birth centers across the country as a study
in the Strong Start program is validating the care that we
already provide," said certified nurse midwife Jessica
Henman, director of the center. "We, as an individual
practice, and the American Association of Birth Centers want
to demonstrate that low-cost, personalized care for women can
vastly improve outcomes for mothers and babies."
percent of the patients at the Birth and Wellness Center use
Medicaid. Nationwide, nearly half of all births are covered by
Medicaid. Medicaid patients typically have twice as many
adverse health outcomes as others, according to a report by
the Medicaid Health Plans of America. Many face food
insecurity, chronic unemployment, unstable housing, lack of
transportation and low levels of education. Preterm birth
alone accounts for 50 percent of all pregnancy costs, largely
due to neonatal admissions, the Medicaid plans report found.
Just one premature baby costs an extra $12,000.
opened three years ago, the Birth and Wellness Center boasts a
preterm birth rate of less than 1 percent and even fewer
babies needing intensive care among its approximately 350
patients who start labor at the center, only 3 percent end up
needing a C-section at a hospital (nationwide birth center
rate is 6 percent), while about 27 percent of low-risk
hospital patients have surgical births. Four weeks after
birth, 100 percent of the birth center’s clients are
breast-feeding, Henman said.
savings come from better health outcomes and a reduction in
medical interventions that have become routine in hospitals
— where studies show that most women receive continuous
electronic fetal monitoring and intravenous fluids, and nearly
half have their labor accelerated with medications. Most
patients are also restricted to bed, not allowed to eat or
drink and give birth lying on their backs. Evidence indicates
that routine use of these practices, with no medical
indication, has little benefit and increases risk for mothers
midwifery model focuses on individualized care. The initial
prenatal appointment lasts about an hour, and subsequent
visits take 30 minutes. Midwives (advance practice nurses)
assess nutrition, exercise habits, health history and stress
factors in order to treat problems early and prevent
complications such as high blood pressure or blood sugar that
can require an early delivery. Questions are encouraged at any
hour. The Strong Start initiative also pairs birth center
patients with a peer counselor who meets with women three
times during their pregnancy and provides another layer of
support and guidance." Our whole model is based on
education and prevention, not just the treatment of a disorder
once it already occurs," Henman said.
things at the birth center, like not having to spend too much
time in the waiting room, make patients less likely to miss
their prenatal appointment for fear of taking too much time
off work or missing day-care arrangements. Missing prenatal
visits can mean missing problems like bladder infections,
cramping or low hormone levels.
recipient Rachel Walker, 18, of Winfield, Mo., delivered a
healthy baby girl just a few days shy of her due date last
month at the birth center. Her first birth, three years ago,
was a different story.
said she had preterm contractions starting at 25 weeks and was
placed on bed rest, a prescription that some experts say is
unproven and could cause harm. Her baby was born at 37 weeks
and suffered severe jaundice.
second pregnancy, Walker said she changed her diet, stayed
active, learned coping skills for stress and took iron
supplements her last trimester. "I definitely received a
lot more information from them than I did from an OB
(obstetrician) about how to take care of myself and my
baby," she said. "I felt like I received more care
and more personal care. They treated me like a person instead
of just a number."
centers still face many obstacles to becoming more accessible
to women — especially in low-income areas — because of
outdated state regulations and low Medicaid reimbursement
rates for their more time-intensive care. The O’Fallon
center is the only licensed and accredited freestanding birth
center in Missouri. A second opened two weeks ago in
Springfield, Mo., and expects licensing and accreditation in
the coming weeks. Mercy Hospital St. Louis also has a
midwife-staffed birth center. In Missouri, freestanding birth
centers fall under the costly regulations of "ambulatory
surgical centers" despite no surgeries taking place. A
doctor is required to oversee the care of every three
midwives; and midwives who are not nurses but credentialed as
certified professional midwives can deliver babies in homes
but not birth centers.
Springfield center chose to open as a nonprofit so it can use
grants and donations to care for the surrounding uninsured and
low-income population, fearing Medicaid’s low reimbursement
would force providers to focus on volume rather than care,
explained the center’s board president, Mary Walsh.
are the people that need the one-on-one care that midwives
provide, that extra time required through pregnancy to get to
know them in personal way and provide the necessary
support," Walsh said. "They need it more than other
the obstacles, Henman said she is working to open another
birth center in north St. Louis or North County, which sees
the area’s worst preterm birth and infant mortality rates,
but where many women are unaware of birth options or lack
want to get this model of care into this community that doesn’t
Google natural childbirth on the Web, but for who it can make
dramatic improvements," Henman said.
said she hopes the findings from the Strong Start initiative
will lead to more friendly state regulations and higher
reimbursements that will help birth centers proliferate.
you have that in place, you will have more birth centers that
can help more women," the birth center association
director said. "That’s ultimately what we want to do,
we want to see care for moms and babies improve."