Perspective from Providers
Key Points Made by Individual Speakers
- Frank Chervenak discussed results of an unpublished analysis he and colleagues performed on U.S. Centers for Disease Control and Prevention data suggesting that depressed 5-minute Apgar scores, stillbirths, and neonatal seizures occur at greater rates in home settings than in hospital settings. He suggested that hospitals should do what is necessary to ensure safety and to consider creating alternative environments.
- Karen Pelote described typical experiences of women who choose to deliver in birth centers. She discussed safety and transfer results from the 2013 American Association of Birth Centers (AABC) Uniform Data Set (UDS) outcomes study (Stapleton et al., 2013) and called for more research on the psychosocial, cost, and other benefits of birth center care.
- Brynne Potter noted the significant disagreement among experts around some of the outcomes reported in published literature. She discussed the safety of home birth from an absolute risk perspective and identified several areas of research that would help to make home birth as safe as possible: access to qualified care providers with appropriate equipment, appropriate risk assessment, communication and collaboration, integrated transfer of data, quality improvement measures, and access to licensure and reimbursement.
NEONATAL OUTCOMES IN RELATION TO
BIRTH LOCATION: ETHICAL IMPLICATIONS FOR
CLINICAL PRACTICE AND RESEARCH1
After encouraging workshop participants to read two papers that he and his colleagues wrote (Chervenak et al., 2011, 2013a), Frank Chervenak highlighted two key points from earlier workshop presentations: (1) The public is insufficiently educated in the importance of maintaining vital data. (2) Centers for Disease Control and Prevention (CDC) birth certificate data are important when considering U.S. births. He remarked, “I think the best database we have today is CDC data.”
Chervenak discussed results from an analysis based on 2007-2010 CDC data (Chervenak et al., 2013b [unpublished data]). The analysis was designed to address two questions: (1) Are there differences between hospital and home births, using Apgar scores and seizures as prognostic
1This section summarizes information presented by Frank Chervenak, M.D., Weill Cornell Medical College, New York, New York.