Groundbreaking CMS study shows better outcomes and lower costs at birth centers

Mom holding baby at The Midwife Center

The Centers for Medicare & Medicaid Services study confirms what we have experienced in our practice for many years, but on a national scale – that women who get their care at birth centers experience better outcomes, on average. - Ann McCarthy, CNM, MSN, Clinical Director of The Midwife Center

The results of a recent groundbreaking study are in: birth centers are coming out on top!

According to the Center for Medicare & Medicaid Services (CMS) study, Strong Start for Mothers and Newborns, individuals with Medicaid who received prenatal care in birth centers like The Midwife Center experienced better birth outcomes compared to the rest of the nation, on average.

Why this study is important

Right now, the U.S. maternity care system is failing our mothers and newborns. We spend more on healthcare than any other country, yet women and newborns experience significant disparities associated with race, poverty, and access to quality care.

  • One in ten births is premature, and Black babies have a higher risk of prematurity
  • Maternity care is one of our nation’s largest healthcare expenditures
  • Preterm birth alone costs over $26 billion per year

Key stats

Researchers collected data on individuals receiving care within enhanced prenatal care models.* The study looked at 8,806 individuals enrolled in Strong Start Birth Centers.**

  • All had Medicaid
  • 10% had a previous preterm birth
  • 33% exhibited symptoms of depression, anxiety, or both

Individuals enrolled in Strong Start Birth Centers experienced better health outcomes, on average, compared to the rest of the nation:

Graph showing strong start data versus national data

Primary c-section rate is for first baby only (Osterman, 2014). Other US numbers are from 2016 (Martin, 2018). Total c-section rate includes repeat c-sections.

What's next?

As midwives and birth center professionals, the study confirmed what we already knew - that birth center clients experience better outcomes, and the maternity care system as a whole experiences lower costs. We are thrilled to see this confirmed by the CMS study. We hope that policymakers at the state and national level will work to improve health outcomes by expanding access to birth center care.

We at The Midwife Center were honored to play a significant role in the study. Due to the success of the study, we have continued to provide information and resource counseling to our clients in addition to new and expanded services like behavioral health and wellness.

You can ensure that more people in the Pittsburgh region have access to safe, evidenced-based prenatal, gynecological, and childbirth care at The Midwife Center. Donate now.

More information:

- CMS's "Findings at a glance" (PDF)
- Full findings at

TMC Clinical Director Ann McCarthy, MSN, CNM with representatives from the American Association of Birth Centers, the Urban Institute, CMS, and the Clinical Director from the Community of Hope - Family Health and Birth Center in Washington, DC

On January 29, 2019, Midwife Center Clinical Director Ann McCarthy, MSN, CNM traveled to Baltimore for the 2019 CMS Quality Conference. She presented on the findings from the study alongside representatives from the American Association of Birth Centers, The Urban Institute, CMS, and Community of Hope-Family Health and Birth Center in Washington, DC.

* What are “enhanced prenatal care models?”

“This initiative tested three evidence-based maternity care service approaches that enhanced the current care delivery and addressed the medical, behavioral and psychosocial factors that may be present during pregnancy and contribute to preterm-related poor birth outcomes. Awardees tested one of the three following interventions...

Enhanced Prenatal Care through Centering/Group Visits - group prenatal care that incorporated peer-to-peer interaction in a facilitated setting for health assessment, education and psycho-social support.
Enhanced Prenatal Care at Birth Centers - comprehensive prenatal care facilitated by teams of health professionals including peer counselors. Services included collaborative practice, intensive case management, counseling and psycho-social support.
Enhanced Prenatal Care at Maternity Care Homes - enhanced prenatal care including psychosocial support, education and health promotion in addition to traditional prenatal care. Services provided expanded access to care, improved care coordination and provided a broader array of health services.”


**What is a Strong Start Birth Center?

As part of this study, 47 birth centers in the United States, including The Midwife Center, received CMS funding through the American Association of Birth Centers (AABC). This funding allowed birth centers to provide “enhanced prenatal care” to clients on Medicaid. In addition to benefiting from the good health outcomes of safe, person-centered birth center care, Midwife Center clients received peer counseling for additional support and referrals.


  • Alliman, J; Stapleton, S., American Association of Birth Centers. Strong Start in Birth Centers: Reducing Disparities and Cost. 2018 Birth Institute in Fort Worth, TX.
  • American Association of Birth Centers,
  • Center for Medicare & Medicaid Innovation. Strong Start for Mothers and Newborns Initiative.
  • Martin, JA, Hamilton, Osterman, et al. (2018) Births: Final data for 2016. NVSR 67 (1). Hyattsville, MD. National Center for Health Statistics.
  • Osterman MJK, Martin JA.(2014). Trends in low-risk cesarean delivery in the United States, 1990–2013. National vital statistics reports; Vol 63 no 6. Hyattsville, MD: National Center for Health Statistics.

Photo by Christina Montemurro Photography

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