Data Systems and Measurement
Key Points Made by Individual Speakers
- William Barth observed most data informing the birth setting dialogue have been observational and retrospective, with no randomized controlled trials of sufficient size on home births.
- How available data are used to inform decision making depends on who is making the decision, with different people valuing outcomes differently and using the same data in different ways. Barth described how the American Congress of Obstetricians and Gynecologists (ACOG) used data from the controversial Wax et al. (2010) meta-analysis to articulate its planned home birth committee opinion (ACOG, 2011).
- Caitlin Cross-Barnet described how Strong Start, a Center for Medicare and Medicaid Innovation (CMMI) initiative, is collecting data on three different models of prenatal care. While the focus is on preterm births, CMMI is collecting data on a range of other outcomes as well. Many birth setting researchers face challenges such as variation in data availability, state-level variation in Medicaid coverage, and inconsistent recording of data on U.S. birth certificates.
- Elliott Main and William Barth each elaborated on several additional data and measurement challenges, such as statistical issues resulting from small sample sizes. For example, given that the total number of home births in the United States per year is 27,000, having sufficient statistical power to detect differences in an outcome like perinatal mortality, which is typically 1 to 2 per 1,000, is very difficult.
of in-hospital deliveries he attends;2 he is a fellow of ACOG, past Chair of the ACOG Committee on Obstetric Practice and primary author of the planned home birth committee opinion (ACOG, 2011), and medical director for a large hospital-based midwifery service in Boston.
ACOG Use of Data for Decision Making
Barth described ACOG’s use of data in its home birth setting committee opinion decision making as a “dance,” one similar to the “dance of legislation” described by Eric Redman in his now classic 1973 book on legislation that led to creation of the National Health Service Corps (Redman, 1973).
The ACOG dance started with a policy statement on home births in the United States issued by the ACOG executive board. The statement contained a couple of what Barth called “lightning rods,” namely, “ACOG strongly opposes home births” and “ACOG does not support programs or
2At the time of the workshop.