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Debra J. Jackson, RN, MPH, DSc, Janet M. Lang, PhD, ScD, William H. Swartz, MD, Theodore G. Ganiats, MD, Judith Fullerton, CNM, PhD, Jeffrey Ecker, MD and Uyensa Nguyen, MPH

At the time of the study, Debra J. Jackson was with The BirthPlace Research Department, San Diego, Calif. William H. Swartz and Theodore G. Ganiats were with the University of California, San Diego, School of Medicine. Judith Fullerton was with the University of Texas at El Paso School of Nursing. Jeffrey Ecker was with Harvard Medical School and Massachusetts General Hospital, Boston. Janet M. Lang and Uyensa Nguyen were with the Boston University School of Public Health, Boston, Mass.

Correspondence: Requests for reprints should be sent to Debra J. Jackson, RN, MPH, DSc, University of the Western Cape, School of Public Health, PO Box 16239, Vlaeberg, Cape Town, South Africa 8018 (e-mail: bessrfam{at}iafrica.com).

Objective. We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care.

Methods. We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.

Results. Major antepartum (adjusted risk difference [RD] = -0.5%; 95% confidence interval [CI] = -2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = -2.4, 4.0), and neonatal (adjusted RD = -1.8%; 95% CI = -3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = -1.3%; 95% CI = -3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = -35.7%; 95% CI = -39.5, -31.8).

Conclusions. For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.