Apgar Wars ~ Birth Center outcomes same as Hospitals — studies do NOT support claimed increase in Zero 5-min Scores ~ 2nd in series

by faithgibson on September 19, 2013

in Contemporary Childbirth Politics

In the obstetrical profession’s Hundred Year War against “other” midwives and OOH birth setting, the newest battle is over Apgars Scores. However a number of studies on free-standing (or ‘independent’) birth center do NOT report differences in critically low Apgars scores compared to hospital, as claimed the the co-author of the AJOG study. 
In light of the 10-fold increase in zero 5-min. Apgars specifically linked by Chervenak et al to OOH place-of-birth, I thought this study’s findings from a physician group was refreshing.

While it primarily reports outcomes of their own physician-led birth center in Missouri — one that  has tunnel access to the main hospital — they also included study data provided for free-standing birth centers in the US and other parts of the developed world.

In particular, the study’s final comment on the issue appears to directly contradict the Wax Meta-analysis, which specifically reported increased neonatal risk specifically associated with low medical-intervention setting.
A … philosophy of fewer obstetric interventions does not appear to lead to a compromise in neonatal well-being.”

Physician-Led, Hospital-Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events, Margaret H. O’Hara, Linda M. Frazier, et al., BIRTH 40:3 September 2013

Excerpt — comparative analysis of Apgars and NICU admissions:

Importantly, the differences in obstetrical interventions in the birth care center group did not compromise maternal and infant well-being.

Infants in the birth care center group overall required care in the high-risk nursery less often than did infants in the hospital group, whereas Apgar scores and high-risk nursery care were equivalent when low-risk women were compared (Tables 1 and 2).

Infant outcomes have been evaluated in most of the birth care center studies.

Employing univariate analysis, we found that there existed no statistically significant difference between Apgar scores of < 7 at 1 and 10 minutes in the birth care center and hospital service, but there existed a slightly higher risk of having lower Apgar scores at 5 minutes in the hospital service.

Infants in the hospital service required a higher rate of transfer to the high-risk nursery than did infants in the birth care center (Relative Risk = 1.28, p = 0.022). Association of delivery location with these adverse outcomes resolved when multivariate regression was utilized.

Our data also suggested that obtaining prenatal care and gaining the appropriate amount of weight during pregnancy decreased the risk that the infant would be transferred to a high-risk neonatal nursery.

Oakley et al (31) also reported no difference in 1- and 5-minute Apgar scores when looking at the outcomes for nurse midwives versus obstetricians. However, they also found that neonatal intensive care admissions were 6.4 percent for the nurse midwives compared with 4.6 percent for the obstetricians.

Waldenstrom et al (12) reported no difference in Apgar scores or infant admissions to neonatal care.

David et al (7) found that Apgar scores of < 7 at 1 minute were higher at the birth care center than in the hospital (3.6% vs 1.9% p = 0.002), but that the difference went away looking at 5-and 10-minute Apgar scores and no increase in neonatal intensive care unit admissions between the two groups.

A possible birth care center-related philosophy of fewer obstetric interventions does not appear to lead to a compromise in neonatal well-being.

Next in series “Apgar Wars~ Best headline for AJOG article should read “Midwife-attended hospital birth two-times safer than MD”


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