BIRTH CENTER DELIVERY - A SAFETY ALTERNAT IVE TO HOSPITAL OBSTETRIC CARE - PERINATAL DATA IN COMPARISON

Purpose: Are there differences in the type and frequency of maternal a nd newborn complications in deliveries at a birth center in comparison to those in hospitals? Is the incidence of operative deliveries, of b irth canal injuries, or increased sub partum blood loss dependent on t he site of delivery? Do newborn and maternal morbidity and mortality r ates differ between collectives from hospital deliveries and birth cen ter deliveries. Method and maternal: In the course of a non-randomized observational study, perinatal data from all 801 deliveries from two birth centers in Berlin were retrospectively recorded from the period August 1, 1992 to July 31, 1994. These data were evaluated and were co mpared to a collective selected ton the basis of the birth centers' ri sk criteria) from 14,367 hospital deliveries from the years 1993 and 1 994 (Chi(2)-Test, significance level of p < 0.01). Results: the incide nce of spontaneous deliveries was significantly higher in the birth ce nter collective (including women subsequently transferred to the hospi tal) than in the hospital collective (91.4% vs. 85.4%). The incidence of cesarean section was similar (3.0 vs. 4.4%, p = 0.057). Maternal an d newborn mortality in the birth center population was zero. In the gr oup of neonates delivered in the birth center, there was a significant ly higher number of newborns with a 1-minute Apgar score less than 7 ( 3.6% vs. 1.9%). The incidence of episiotomy among the hospital populat ion was considerably higher than that seen in the birth center populat ion (70% vs. 16%), even though the incidence of perineal injuries was similar (ca. 1%). A total of 18% of the women were sub partu and 2.6% of neonates were referred to a hospital from one of the two birth cent ers. Conclusion: If risk selection criteria are adhered to and with ti mely transfer to nearby hospitals, if necessary, deliveries performed at birth centers are comparable to hospital deliveries with regard to perinatal outcomes.