Does birth setting impact birth outcome? Baby Childbirth Coronavirus covid Csection Gynecology Healthcare Hospital MaternaHealth MidwiferyMortality Obstetrics Pandemic Research AJOG_thegray
Expert Review: The impact of birth settings on pregnancy outcomes in the United States. Image Credit: christinarosepix / Shutterstock
Direct data comparing births in and out of hospital is lacking. Moreover, some home births become complicated and end up in hospital, with the resulting adverse outcomes becoming part of the hospital’s outcomes instead of being attributed to the original outside-hospital delivery pathway. What did the study show? The study identified the shortfalls in data regarding deliveries in hospital and outside. The Centers for Disease Control and Prevention maintains statistics on the 3.5 million births in the USA each year. However, they are registered to the institution where they occurred and not where they were intended to occur.
The researchers compared births assisted by a hospital midwife to those assisted by CNMs at home, other midwives at home, and unintended home births. In all cases, when compared with those births performed by a hospital midwife, the mortality among the newborns was more than two to eight-fold higher in home births.
These risks are higher in certain patient groups, such as first-time deliveries, elderly mothers , those who are at or past 41 weeks of pregnancy, and those with a diagnosed breech presentation or a history of C-section. However, there is conflict between the medical and midwifery communities on the contraindications for home births, with the result that standardized exclusionary guidelines for home births are still awaited.
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