Dueling Statistics: Is Out-of-Hospital Birth Safe?

Goer, Henci

doi:10.1891/1058-1243.25.2.75

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…Out of the 31 articles, 20 articles reported an increase in fear and anxiety from pregnant women. [26][27][28][29][30][31]33,34,[36][37][38][39][40][41][42][43][44][47][48][49][50][51][53][54][55][56][57]59,[61][62][63][64] The primary fear that emerged in the articles was a fear of contracting COVID-19 while at the hospital during delivery. Additionally, pregnant women reported being anxious about potentially giving birth alone, being separated from their newborns, and an increased medicalization of their birth.…”

Section: Case Report Uncertaintymentioning

confidence: 99%

“…Particularly when considering findings like an increased risk for first‐time pregnancies, specifically those 41 or more weeks gestation presented by a study recommending against out‐of‐hospital births 28 . Adverse outcomes were observed for both planned and unplanned out‐of‐hospital births 27,28 . Ultimately, the risks and benefits of out‐of‐hospital births varied based on risk profile with particularly unclear results for high‐risk women 22 .…”

Section: Introductionmentioning

confidence: 99%

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Challenges and lessons learned birthing during the COVID‐19 pandemic: A scoping review

Knox‐Kazimierczuk,

Trinh,

Odems

et al. 2023

Health Science Reports

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Background and Aims: The impact of the COVID-19 pandemic on the healthcare system facilitated a change in policies to redress the consequences of increased demand and fear of disease transmission. Restrictive measures throughout the healthcare system limiting access to accompanying partners of birthing people in addition to fears of contracting COVID-19, an increasing number of birthing people chose to have an out-of-hospital birth. Out-of-hospital births are not prevalent in the United States. However, in recent years the percentage of out-of-hospital births has been steadily increasing. COVID-19 was a novel virus imposing a unique birthing situation for millions of women, complicated by lack of integration and varied policies in the U.S.Methods: To better understand the challenges of birthing people during the pandemic a scoping review was conducted to explore the literature during the first wave of the pandemic related to out-of-hospital births. The approach for this review made use of the methodology manual published by the Joanna Briggs Institute for scoping reviews. All manner of publications (i.e. peer-reviewed published articles, grey articles, conference proceedings, webinars, editorials, and textbook chapters) were included in the review.Results: Articles retrieved from the database search yielded sixty-three articles, after duplicate removal forty-six records were available for screening. Articles were further excluded using the PRISMA process, yielding thirty-one remaining records.From the thirty-one records twelve themes emerged, which were collapsed into four meta-themes. Conclusion:These meta-themes focused on (a) advocacy, (b) homebirth infrastructure, (c) support networks, and (d) uncertainty during the pandemic. COVID-19 has accelerated this movement to birthing at home and thought must be given to how the healthcare system is going to support and integrate this mode of birthing.

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Section: Case Report Uncertaintymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Challenges and lessons learned birthing during the COVID‐19 pandemic: A scoping review

Knox‐Kazimierczuk,

Trinh,

Odems

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

show abstract

“…Many healthcare providers postulate that this shift reflects a fear of the hospital and associated risk for contracting COVID-19 rather than a real desire for an out-of-hospital birth [20,21]. Though out-of-hospital birth can be as safe as in-hospital births (and perhaps even safer than inhospital births for certain low-risk individuals [22,23]), it is generally recognized by home-birth and hospitalbirth providers alike that planning an out-of-hospital birth out of fear or panic caused by rising rates of infection, or switching to a homebirth late in pregnancy, is not ideal [20,21].…”

Section: Introductionmentioning

confidence: 99%

Perinatal health care access, childbirth concerns, and birthing decision-making among pregnant people in California during COVID-19

Whipps

Phipps

Simmons

2021

BMC Pregnancy Childbirth

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Background During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care. Methods We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a ‘non-surge’ wave (June 2020, n = 433), and (2) during a ‘surge’ in cases (December 2020, n = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities – including acute financial insecurity and racial/ethnic minoritization – are associated with access, concerns, and decision-making over these two waves. Results Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020–2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 ‘lull’ in the summer of 2020. However, across ‘surge’ and ‘non-surge’ pandemic circumstances, marginalized pregnant people continued to fare worse – especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous. Conclusions It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California.

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“…I am not sure how many readers really took this message away from the article as the popular media tended to stress a doubling of risk without qualification. I encourage clients to read this study along with the larger body of literature on home and birth center birth safety [see Goer, 2015, for a great starting place] because the authors of the NEJM piece are themselves careful to stress in their "Limitations" section that the sample size for OOH births was small in the Oregon study. In fact, the entire study is based on 10 deaths in the OOH sample.…”

mentioning

confidence: 99%

“…As Henci so clearly stated in her Science and Sensibility piece [Goer, 2015], midwives alone cannot be held responsible for creating an integrated system. A willingness to increase safety through meaningful collaboration must also come from the medical establishment.…”

mentioning

confidence: 99%

Understanding Recent Home-Birth Research: An Interview With Drs. Melissa Cheyney and Jonathan Snowden

Cheyney¹

2016

J Perinat Educ

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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 literature that consistently shows high rates of obstetric intervention in hospitals and also show low risk to neonates regardless of setting. However, the recent NEJM study found a small but statistically significant increase in risk for perinatal mortality for babies born out of hospital. Jeanette McCulloch of BirthSwell (http://www.birthswell.com) interviews Melissa Cheyney, PhD, CPM, LDM, medical anthropologist, chair of the Midwives Alliance Division of Research, and lead author on the largest study of outcomes for planned home births in the United States to date (Cheyney et al., 2014a), and Jonathan Snowden, PhD, epidemiologist and assistant professor in the Department of Obstetrics and Gynecology and School of Public Health at Oregon Health and Science University. Snowden is also the lead author of the recent NEJM study.

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Dueling Statistics: Is Out-of-Hospital Birth Safe?

Cited by 5 publications

References 10 publications

Challenges and lessons learned birthing during the COVID‐19 pandemic: A scoping review

Challenges and lessons learned birthing during the COVID‐19 pandemic: A scoping review

Perinatal health care access, childbirth concerns, and birthing decision-making among pregnant people in California during COVID-19

Understanding Recent Home-Birth Research: An Interview With Drs. Melissa Cheyney and Jonathan Snowden

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