Assessment of interprofessional collaboration at free-standing birth centers: Does collaboration influence outcomes?

Rates of maternal morbidity and mortality in the United States lag behind other high-income countries. One proposed solution is to develop an integrated system of maternity care consisting of levels of care based on medical risk. As smooth transitions between different levels will be necessary, better definition of successful collaboration in this context is needed. To evaluate if collaborative activities between free-standing birth centers and their collaborative obstetric departments are associated with birth outcomes. The American Association of Birth Centers manages a large prospective perinatal registry, and also performs surveys of all known birth centers that collect data on practice characteristics. Specific collaborative activities were mapped to birth outcomes. Outcomes from centers that participated in these activities were compared to practices that did not. Participating in review of transfers, hospital department meetings, and QI activities resulted in statistically significant lower cesarean sections, as did participating in emergency drills. Attending social events with the department and attending classes at the hospital resulted in statistically significant higher rates of transfer from birth center to hospital. These transfers occurred without a concurrent increase in cesarean sections. Certain collaborative activities between birth centers and obstetric departments are associated with improved birth outcomes.