hours?); and the types of patients studied (e.g., the type of patient interested in one setting might be different than the type of patient interested in another setting).

UK Collaborative Group Studies

A key point for Spong from Jane Sandalls’s presentation on the UK Collaborative Group Studies was that low-risk women have very rare adverse perinatal outcomes. Other important messages were that women in their first pregnancy have higher risks than women who have had a prior successful pregnancy and that interventions occur more often in hospital settings.

In Spong’s opinion, factors to consider when evaluating the results from these and other similar studies include choice of birth setting, patient bias, and caregiver staffing and roles.

Process of Care

Spong said that a major component from Carol Sakala’s presentation on process of care was that the overall goal is fewer interventions.

Factors to consider when evaluating the evidence presented by Sakala and other similar evidence include institutional polices (e.g., the goal may be fewer interventions, but if there is a policy in place that all patients must receive a particular intervention, then all patients will receive it regardless of whether they need it), caregiver staffing and roles, selection bias, and outcomes measured (e.g., is a 5-minute Apgar score enough?).

Effect of the Built Environment

A significant point for Spong from Esther Sternberg’s presentation was that environment affects health, with both neuroendocrine and physiologic responses to what is happening in the environment impacting both mental and physical health.

An important factor to consider when evaluating the research presented by Sternberg and other similar research is that much of the data are from nonobstetrical populations. It is unclear how applicable the results are to obstetrical populations.


Spong identified several overarching factors to keep in mind when evaluating the evidence from these studies on birth settings and health outcomes, indeed when evaluating the evidence from any of the research described during the workshop or when planning future research:

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