摘要：Objective. We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care. Methods. We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care. Results. Major antepartum (adjusted risk difference [RD] = −0.5%; 95% confidence interval [CI] = −2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = −2.4, 4.0), and neonatal (adjusted RD = −1.8%; 95% CI = −3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = −1.3%; 95% CI = −3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = −35.7%; 95% CI = −39.5, −31.8). Conclusions. For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care. The National Birth Center Study 1 and other studies comparing birth center deliveries with traditional hospital deliveries 2– 7 report favorable outcomes and fewer obstetric interventions in the birth center groups. These studies have been considered inconclusive because of concern that women choosing to deliver at a birth center may have been healthier than women seeking traditional perinatal care. 8, 9 In our study we evaluated the safety and resource utilization of a practice model that included collaborative certified nurse–midwife (CNM)/obstetrician management of perinatal care and a freestanding birth center option for delivery. We paid rigorous attention to the initial perinatal risk of all the women in the study.
