Among the many health care debates stimulated by the pandemic caused by coronavirus disease 2019 , questions of birth setting risk may be one of the most contentious. US births predominantly occur among healthy people and in the hospital, requiring pregnant people and perinatal care providers to grapple with birth setting assessment related to the virus. The pandemic rapidly recalibrated perceptions of labor and birth settings, with reports that many pregnant individuals were seeking community birth options (birth intended in the home or birth center setting) because of concern over in-hospital exposure and/or loss of autonomy. 1 This adds urgency to recent policy discussions of how, where, and by whom perinatal care is provided, as well as the need to address long-standing racial disparities in pregnancy and birth outcomes. 2 We highlight current barriers and opportunities to advancing birth equity and perinatal care integration in light of the novel coronavirus pandemic.
BIRTH SETTINGSAs coronavirus was emerging, the National Academy of Medicine released a long-awaited report, Birth Settings in America, that discussed safety and risk across birth settings. 2 Years prior to the pandemic, the National Academy of Medicine assembled experts to analyze the birth setting literature, and they concluded that for healthy pregnancies, safety is maximized and risk minimized when perinatal care is integrated. The Birth Settings in America report identified 5 characteristics of integrated care [Table 1]. This report also reaffirmed the responsibility of all involved in perinatal care to address and abate racial and ethnic disparities. The key challenges and opportunities identified in this report have since been amplified by pandemic-related changes.