Strong Start Innovation: Equitable Outcomes Across Public and Privately Insured Clients Receiving Birth Center Care.
Diana Jolles, Lauren Hoehn-Velasco, Lisa Ross and 6 others
PMID 36480161WHAT IT FOUND
In birth center care, Medicaid clients who had peer counselors had similar core maternal and newborn outcomes to privately insured clients.
Medicaid clients without peer counselors had more epidural use and less exclusive breastfeeding.
Key findings
01After controlling for medical risk factors, Strong Start Medicaid beneficiaries had no significant differences in maternal or newborn outcomes compared with privately insured consumers.
02Non-Strong Start Medicaid beneficiaries had similar adjusted outcomes except higher epidural analgesia use and lower exclusive breastfeeding on discharge than privately insured consumers.
03Before adjustment, exclusive breastfeeding on discharge was 96.0% among privately insured consumers, 86.8% among Strong Start Medicaid beneficiaries, and 84.0% among Medicaid beneficiaries not enrolled in Strong Start.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was an observational registry analysis, not a randomised trial, so it cannot show that peer counselors caused the outcomes. The authors note unquantifiable selection bias because people who choose birth centers may differ from those who do not. The groups differed before adjustment in age, education, marital status, race and ethnicity, planned birth place, and several outcomes, so adjustment may not remove all differences. Both Medicaid groups received midwifery-led birth center care, and the analysis did not separate the effects of peer counselors, longer prenatal visits, doulas, community health workers, or other enhanced services. Attrition and transfer rates varied between groups and may reflect differences in intended place of birth rather than care quality alone.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that peer counselors caused similar outcomes. This was an observational registry analysis, not a randomised trial, and both Medicaid groups received midwifery-led birth center care, so the contribution of peer counselors cannot be separated from the birth center model.