Birth Setting

New Largest Ever Waterbirth Study

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Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes

Abstract Background Fetal macrosomia is associated with negative outcomes, although less is known about how severities of macrosomia influence these outcomes. Planned community births in the United States have higher rates of gestational age‐adjusted macrosomia than planned hospital births, providing a novel population to examine macrosomia morbidity. Methods Maternal and…

Factors affecting third-stage management and postpartum hemorrhage in planned midwife-led home and birth center births in the United States

Abstract Background Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third‐stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery.…

Current Resources for Evidence-Based Practice, May 2020

Abstract An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of a new National Academy of Medicine report on planned place of birth and implications during the SARS-CoV-2 pandemic and commentaries on reviews focused on anorectal…

The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Abstract BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. METHODS Our multi-stakeholder team…

Asking different questions: A call to action for research to improve the quality of care for every woman, every child

Abstract Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the…

Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Abstract Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked…

Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States.

Abstract BACKGROUND: There is little agreement on who is a good candidate for community (home or birth center) birth in the United States. METHODS: Data on n=47 394 midwife-attended, planned community births come from the Midwives Alliance of North America Statistics Project. Logistic regression quantified the independent contribution of 10 risk…

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Abstract BACKGROUND Women seeking VBAC may find limited in-hospital options. Increasing numbers of US women are delivering by VBAC out-of-hospital. Little is known about neonatal outcomes among those delivering by VBAC in vs. out-of-hospital. OBJECTIVE(S) To compare neonatal outcomes between women delivering via VBAC in hospital vs. out-of-hospital (home and…

Understanding Recent Home-Birth Research

Abstract In the past month, two new studies have been released—one in The New England Journal of Medicine (NEJM; Snowden et al., 2015) and the other in the Canadian Medical Association Journal (Hutton et al., 2015)—comparing out-of-hospital birth outcomes to hospital birth outcomes. These studies join a growing body of…

Making US Out-of Hospital Birth Safer Requires Systems Change

Abstract Birth is as safe as life gets. – Harriette Hartigan, direct-entry midwife What one deems “safe” is inherently subjective, involving a series of judgments and a relative weighing of multiple (and sometimes conflicting) factors. Find full study Subscription only. To request a copy, contact us here Citation Tilden, E.,…