Client Experience with the Ontario Birth Center Demonstration Project.
Jessica Reszel, Deborah Weiss, Elizabeth K Darling and 9 others
PMID 33336882WHAT IT FOUND
Women in Ontario midwifery care reported satisfaction scores averaging 19.2 of 20 for birth center, home, and hospital births.
Hospital-intended births had the lowest score, and most women intending a birth center birth would choose one again.
Key findings
01Satisfaction scores averaged 19.2 of 20 overall, and scores differed significantly by intended place of birth: birth center 19.4, home 19.5, hospital 18.9.
02Among 191 women intending a birth center birth, 143 were admitted to a birth center and 125 gave birth there; 84.7% would choose a birth center again.
03Of 155 women admitted to a birth center, 18 were transferred to hospital, a rate of 11.6%; all 18 understood the reason for transfer, and 14 would not change the transport experience.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The survey response rate was 54.6%, and the authors had no data on nonresponders, so the results may not represent all midwifery clients. Most respondents were well educated and spoke English, so the findings may not reflect clients with lower education or who do not speak English or French. The Composite Satisfaction Score was developed for this study and not validated, so small differences may be hard to interpret. Women were surveyed 3 to 6 weeks after birth, and satisfaction ratings may change over time. Three respondents missing one question were assigned the mean value for that question, although a sensitivity analysis excluding them confirmed the main findings. The analysis used intended place of birth at the start of labor, not actual birth location; 12 women classified in the hospital group gave birth at a birth center. The survey transfer rate was 11.6% among admitted women, lower than the reported 26.3% overall transfer rate, and the reason is unknown. This was an observational survey of reported experience, so it cannot show why satisfaction scores differed or whether birth centers caused better outcomes.
Declared interests
The authors report no conflicts of interest to disclose.
The easy way to misread this
Do not read the lower hospital satisfaction score as proof that hospital birth is worse or that birth centers improve outcomes. This survey measured reported experience 3 to 6 weeks after birth, and the study did not test whether the birth center model caused the satisfaction differences.