Nursing ETDs

Publication Date

Fall 10-29-2020

Abstract

Pregnant women from all racial and socioeconomic communities deserve safe, personalized, and affordable ways to give birth. To meet all three needs, focus is increasing on birth centers, a midwifery model that provides family-centered care before, during, and after normal pregnancy, labor, and birth. However, many U.S. birth centers face significant obstacles to financial sustainability, particularly in rural areas. A better understanding of the factors that contribute to a birth center’s operational success is needed for practitioners and groups interested in establishing or maintaining a birth center, as well as to inform policymakers seeking to improve health care equity, outcomes, and cost markers. This study examined organizational aspects of birth centers to determine which factors predicted long-term financial health and stability, within a conceptual framework of program sustainability and system dynamics, using data gathered by the American Association of Birth Centers. Bivariate correlations indicated that the availability of state licensure and urban/suburban/mixed geographic location positively correlated with birth centers’ financial sustainability. Multinomial logistic regression modeling indicated that the relative odds of “excellent” versus “good” financial sustainability were nearly eight times greater (OR 7.78) for birth centers located in states in which licensure was available compared with states in which licensure was not available. In addition, the relative odds of “good” vs. “poor” financial sustainability were more than seven times greater (OR 7.13) for for-profit birth centers compared with those run as a nonprofit, controlling for all other variables in the model.

In alignment with the recent findings of the national Strong Start for Mothers and Newborns Initiative (Alliman & Bauer, 2020), the results of this research offer actionable insights for maternal-health stakeholders to establish and maintain excellent, equitable, and cost-effective care through birth centers.

Degree Name

Nursing

Level of Degree

Doctoral

Department Name

College of Nursing

First Committee Member (Chair)

Roberta Lavin, PhD, FNP-BC, FAAN

Second Committee Member

Mary K. Barger, PhD, CNM, MPH, FACNM

Third Committee Member

Patricia Watts Kelley, PhD, GNP-BC, FNP-BC, FAANP, FAAN

Fourth Committee Member

Mark Parshall, PhD, RN, FAAN

Sponsors

Johnson & Johnson, San Diego Hispanic Nurses Association

Keywords

Health care policy, midwifery, birth centers, equity, obstetrics, health care management

Language

English

Document Type

Dissertation

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