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Introduction Institute of Medicine (IOM) of the National Academy of Sciences (NAS) collaborated in this study with the Board on Maternal, Child, and Faaily Health Research of the Commission on Life Sciences of the National Research Council (NRC) to determine methodologies needed to evaluate current childbirth settings in the United States. Although the proportion of nonhospital births runs as high as 4.4 percent annually in Oregon, insufficient data exist to permit complete evalu- ation of the various birth settings. The application of good research aethods should lead to scientific £indings that provide the basis for informed, rational decision making about alternative settings for child- birth. A comaittee of 11 experts was appointed to review current knowledge, provide background knowledge, and identify the kinds of research designs useful for assessing such matters as the safety, quality of maternity care, costs, psychological factors, and family satisfaction of different birth settings. comaittee was also charged with preparing a report that could be used to solicit, evaluate, and fund proposals for studies on childbirth settings. The comaittee did not design specific studies to be carried out, but rather atta.pted to point out issues that should be considered by researchers because it believed that the best pro- posals would arise froa investigator-initiated research. Gaps in research could be filled by requests for proposals developed by agency staff and the agency peer review c~ittee. In addition, IOM staff aeabers and several consultants provided background papers for the co.aittee's consideration. The research that results from this report will be useful to policyaakers and to consumers searching for infor- mation to aid in making decisions about birth settings. 1