Cecilia Jevitt
Yale University
Cecilia Jevitt is the midwifery and women's health nurse practitioner specialties coordinator, Yale University, with 35 years of midwifery practice experience. Her scholarship focuses on weight and obesity management in pregnancies.She developed the concept of advantage lists – lists of evidence-based, patient self-care behaviors that improve health (advantages).
Background: Perinatal health complications increase linearly as prepregnancy BMI exceeds 30. Perinatal outcomes in birth centers have not been analyzed by BMI class. This study describes outcomes for women with obese BMIs who received care in the AABC accredited birth centers.
Methods: Data from 41,029 pregnancies registered in the American Association of Birth Centers Perinatal Data Registry were reviewed. The Yale Center for Analytical Sciences analyzed data from nulliparas to remove the effects of parity and age on birth outcomes and prevent women from being analyzed more than once, leaving 11,998 births (BMI classes: normal BMI n=5881 [49.02%], overweight n=2058 [17.15%], obese n=1084 [9.03%]) for comparisons. Most women with obese BMIs ranged from 30-34.9 (66.7%, Class I) and 35-39.9 (23.8%, Class II). Frequencies and multiple regression analysis for more than 20 variables were completed.
Results: Women had a mean age of 28 years and 14.5 years education. Women with obese BMIs were significantly more likely than women of normal BMIs to have government insurance for pregnancy, to be Hispanic or African American, and less likely to be married (p <0.001). Women with obese BMIs had twice the rate of gestational diabetes, post term pregnancy and macrosomia and three times the rate of hypertensive disorders than women of normal BMIs (p <0.001). Of women receiving prenatal care in birth centers, 71.48% of women with normal BMIs but 47.97% of women with obese BMIs started labor at the birth center (p <0.001) where 99% of care was provided by midwives. Of women with obese BMIs starting labor at a birth center, 68.46% gave birth at the center compared 79.04% of women with normal BMIs . There were no significant differences between intrapartum or postpartum complications between women of normal and obese BMIs whether birth occurred in the birth center or the hospital. For nulliparas of normal BMIs and obese BMIs rates of induction of labor (10.56%, 7.93%, p=0.31), augmentation of labor (48.13%, 44.51%, p=0.39) and cesarean birth (35.64%, 36.59%, p=0.74) were similar. Midwives were the primary hospital care provider for half of women transferred regardless of BMI. Newborn outcomes were similar between women of normal and obese BMIs.
Discussion: Women with obese BMIs who received prenatal care at AABC accredited birth centers had few antepartum, intrapartum or postpartum complications. Women with elevated BMIs but otherwise healthy may have self-selected for birth centers. They had higher rates of hospital admission for birth but similar outcomes in hospitals as women of normal BMIs with a cesarean birth rate almost equal to that of women with normal BMIs. Factors that might explain the healthy outcomes include the health maintenance focus and the physiologic approach to labor embedded in midwifery care.
Conclusion: Women with obese BMIs who have appropriate screening and midwifery care within a system of care can safely give birth in birth centers. Women with obese BMIs without co-morbid health conditions have similar perinatal outcomes as women with normal BMIs when receiving midwifery care in birth centers.
Studies of and contributions to practice and/or service organisation , The identification and examination of relevant outcomes relating to labour and birth
