BOX 9-1
Workshop Reflections: Moving the Research Agenda Forward
Key Points Made by Individual Speakers

  • Catherine Spong identified several factors to keep in mind when evaluating the evidence presented at this workshop, especially the evidence on outcomes among different birth settings. These factors include: how outcomes are driven by the institutional norms and policies of a birth setting, regardless of type of birth setting; caregiver staffing and roles; types of patients studied; selection bias; and outcomes measured (e.g., is a 5-minute Apgar score enough?).
  • Spong emphasized the need for more research on long-term outcomes, on women at increased risk, and on neural-immune connections in obstetric populations.
  • Spong also stressed the importance of recognizing the limitations of available data and the limitations of generalizing research findings.
  • Zsabeka Henderson noted there are many knowledge gaps still remaining, even though several additional birth setting data sources have become available since the 1982 Institute of Medicine (IOM) and National Research Council (NRC) report. In particular, birth certificate data do not capture planned home births transferred to hospitals or intended place of birth for either hospital or birth center births; very large datasets are needed to detect differences in perinatal mortality; and there is no uniform data platform to adequately compare birth settings.
  • Henderson identified several key research needs discussed by workshop participants that could serve as a starting point for a future research agenda. These research needs range from evaluation of outcomes across birth settings to research on access to care in various birth settings.
  • So that research can inform policy and practice, Henderson also identified several nonresearch gaps that need to be addressed. Most importantly, in Henderson’s opinion, and the most important take-home message of the workshop for her, is the need to improve interprofessional education, communication, and interaction.

Alternative Versus Conventional Settings

An important conclusion and major message for Spong from Ellen Hodnett’s presentation on alternative hospital settings versus conventional hospital settings was that alternative settings impact, and in many cases reduce, interventions.

Spong identified several factors to keep in mind when evaluating the evidence that Hodnett presented and other similar evidence: how outcomes are driven by the institutional norms and policies of the birth setting, regardless of type of birth setting; caregiver staffing and roles, including what types of caregivers are present and the timing of their care (e.g., Are caregivers present for only 8 hours at a time, or did they stay for 24-36



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