Delivering maternity care in a non-traditional setting

hospital building with a sign that says outpatient

Alternatives to the traditional hospital model are taking the healthcare industry by storm, and outpatient care for mothers giving birth may be the next wave. Outpatient birth centers could also help achieve healthcare’s Triple Aim.

Birth is a major driver of hospitalization, and the United States as among the highest maternity care costs in the world. Despite this, pregnant women often do not require costly inpatient care, and a model that applies the principles of ambulatory care to maternity care is gaining steam within the industry, according to the Journal of the American Medical Association.

In 2014, the United Kingdom’s National Institute for Health and Care Excellence announced that midwifery units and birth centers had comparable outcomes to hospitals; birth centers exist in the United States already, but they account for less than 1 percent of deliveries.

The authors attribute this to lack of integration between such institutions and area clinicians and inpatient hospitals; this lack of integration hurts outcomes and patient safety, as does inconsistent regulation.

Done properly, the model includes not only strong integration with local care systems but appropriate risk stratification and around-the-clock support. The model should be heavily patient-centered as well, involving eligible women as well as their midwives or OB-GYNs in the shared decision-making process.

However, the authors write, implementation of care integration for such centers in the U.K. shows the model can be improved, especially when U.S. patients increasingly make healthcare decisions based on convenience and want to avoid intervention wherever necessary. “As a society with increasing healthcare costs, it makes little sense to pay for inpatient care for women who neither need nor want it,” they write.

The model’s potential echoes similar trends that rethink the normal hospital model, such as “bedless hospitals,” standalone emergency rooms and “micro-hospitals.”