Strong Start Innovation: Equitable Outcomes Across Public and Privately Insured Clients Receiving Birth Center Care

Area of Science:

• Health Services Research
• Maternal and Child Health
• Health Equity

Background:

• The Birth Center model is a long-standing healthcare innovation in the US.
• Poverty-related health disparities persist among childbearing families.
• Evaluating innovative care models is crucial for addressing these disparities.

Purpose of the Study:

• To assess the Birth Center model's effectiveness in reducing health disparities.
• To compare outcomes for privately insured individuals and Medicaid beneficiaries within birth centers.

Main Methods:

• Secondary analysis of 26,259 participants from the American Association of Birth Centers Perinatal Data Registry (2013-2017).
• Comparison of privately insured individuals with two Medicaid groups: Strong Start enrollees (midwifery + peer counselors) and non-Strong Start beneficiaries (midwifery only).
• Logistic regression controlling for medical risk factors to analyze perinatal outcomes.

Main Results:

• Strong Start Medicaid beneficiaries had similar maternal and newborn outcomes to privately insured individuals after risk adjustment.
• Medicaid beneficiaries without peer counselors showed similar outcomes but higher epidural use and lower breastfeeding rates compared to privately insured.
• No significant differences were observed in induction, epidural use, cesarean birth, breastfeeding, Apgar scores, low birth weight, or transfer of care between Strong Start Medicaid and privately insured groups.

Conclusions:

• The midwifery-led birth center model, enhanced by peer counselors, offers a viable strategy for achieving health equity.
• This model effectively mitigates disparities for Medicaid beneficiaries, providing comparable outcomes to those with private insurance.
• Peer support within a midwifery-led framework appears key to improving outcomes and reducing disparities in maternal care.