Community Versus Out‐of‐Hospital Birth: What's in a Name?

Cheyney, Melissa; Bovbjerg, Marit L.; Leeman, Lawrence; Vedam, Saraswathi

doi:10.1111/jmwh.12947

Cited by 17 publications

(14 citation statements)

References 33 publications

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“…Transfer of care from home or birth center to hospital in the United States has been a source of dissatisfaction, or even trauma, for women, and may be leading to delays in decisions to seek assistance. 89 Midwives and physicians have been found to struggle with interprofessional consultations around planned home birth, and those tensions are greatest during transfer from home to hospital. 90 The tensions reflect differing perceptions of safety and risk, and an understanding of each other's' scope of practice, roles, and expectations.…”

Section: Discussionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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Background: The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.

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Section: Discussionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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“…Choosing to give birth in an out‐of‐hospital environment—at home or in a birth center—also known as community birth, 1 is an uncommon choice in the United States. Although rates of community births have increased in the United States since 2004, they still accounted for < 2% of births in 2017 2 .…”

Section: Introductionmentioning

confidence: 99%

The role of pandemic‐related pregnancy stress in preference for community birth during the beginning of the COVID‐19 pandemic in the United States

Preis

Mahaffey

Lobel

2021

Birth

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Background The COVID‐19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. Methods This study included 3896 pregnant women from the COVID‐19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic‐related preparedness stress, and pandemic‐related perinatal infection stress. Results Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID‐19. In multivariate models, higher stress about perinatal COVID‐19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. Discussion Women's birth preferences during the COVID‐19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in‐hospital and out‐of‐hospital birth services should be encouraged.

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“…In the United States, pregnant persons may choose to give birth in the hospital, at a freestanding birth center, or in their own home. Births that occur outside the hospital can be considered community births , 1 a term that decenters the hospital as the default location for birth. Although the percentage of community births increased between 2004 and 2017, use of community birth remains quite low; approximately 1.6% of birthing persons choose to give birth outside a hospital 2 .…”

Section: Introductionmentioning

confidence: 99%

Concerns of Women Choosing Community Birth During the COVID‐19 Pandemic: A Qualitative Study

DeJoy

Mandel

McFadden

et al. 2021

J Midwife Womens Health

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Introduction During the coronavirus disease 2019 (COVID‐19) pandemic, midwives have reported increased demand for community birth services. The purpose of this qualitative study was to understand childbearing persons’ decision‐making during the pandemic and to illuminate their experiences giving birth in community settings. Methods The study was framed by the interpretive phenomenological approach. Eligible participants were recruited from midwives providing out‐of‐hospital birth services. Of the 26 women who agreed to an interview, 17 were able to be reached and interviewed. Interviews followed a semistructured guide. Early paradigm cases were coded by all researchers, and then the first author coded the remaining transcripts. The final thematic structure was developed by the research team through an iterative process and validated through member checking. Results Four themes were identified: prior desire for a community birth, perceived susceptibility, barriers to choice, and isolation. Discussion Many participants had a preexisting desire for community birth and used the pandemic to justify their choice. However, birth options were often limited by finances and geography. Attitude toward COVID‐19 varied by knowledge and experience. Many participants experienced stress and isolation.

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Community Versus Out‐of‐Hospital Birth: What's in a Name?

Cited by 17 publications

References 33 publications

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

The role of pandemic‐related pregnancy stress in preference for community birth during the beginning of the COVID‐19 pandemic in the United States

Concerns of Women Choosing Community Birth During the COVID‐19 Pandemic: A Qualitative Study

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