An Update on Research Issues in the Assessment of Birth Settings Workshop Summary (2013) / Chapter Skim
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8 Perspective from Providers
8 Perspective from Providers
Pages 133-144
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From page 133... ...
, and a certified professional midwife (CPM) who attends home births in private practice (Brynne Potter)
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Are there differences between hospital and home births, using Apgar scores and seizures as prognostic 1 his T section summarizes information presented by Frank Chervenak, M.D., Weill Cornell Medical College, New York, New York.
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From page 135... ...
Among all midwife-attended births, only 6 percent occurred at home, but 25 percent of neonatal seizures that occurred with midwifeattended births occurred at home. In sum, Chervenak said that, regardless of which of the three outcomes one examines, all were significantly increased among midwife-attended home births compared to hospital births: a twofold increase for depressed 5-minute Apgar scores, an 18-fold increase for stillbirths, and a fivefold increase for neonatal seizures.
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From page 136... ...
He asked, "How could this be happening, given the lower Apgar scores that I just reported? " He explained that the greater number of Apgar scores of 10 for home births accounted for the greater average Apgar scores, even though the rate of depressed Apgar scores at 5 minutes was higher for home births.
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outcomes study results showed that 84 percent of women who start care at a birth center deliver at the birth center, with 93 percent having vaginal deliveries regardless of the actual birth setting (Stapleton et al., 2013)
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Pelote believes that a greater understanding of the barriers to care for African American women and why they do not choose birth centers would help to improve outcomes for African American women. The 2013 AABC UDS study showed a 12 percent referral rate to hospitals among women admitted to birth centers for labor and fewer than 1 percent of the women required emergency transfer during labor (Stapleton et al., 2013)
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From page 139... ...
": that home birth providers are marginalized and not integrated into the system. She acknowledged that integrating home birth providers into the system will be disruptive; whether that is a "good" or "bad" thing depends on 3 his T section summarizes information presented by Brynne Potter, CPM, Private Practice, Charlottesville, Virginia.
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From page 140... ...
Women choose home births for a range of reasons (Blix, 2011; Boucher et al., 2009; Hendrix et al., 2010; Hildingsson et al., 2003, 2010; Jackson et al., 2012; Lindgren and Erlandsson, 2010; Symon et al., 2010)
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. Potter concluded with a discussion of the concept of "home birth–like." For her, home birth–like means woman-centered, family friendly (engaging whoever the woman identifies as family)
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From page 142... ...
DISCUSSION WITH THE AUDIENCE4 After Potter's presentation, there was a brief discussion between the panelists and audience on the following topics: the risk of labor and the need for standardization in out-of-hospital settings; the need for hospitals to be more supportive of undisturbed physiologic childbirth; the need for a paradigm shift to evidence-based care; questions about data presented by Frank Chervenak; and ways to make home births safer. The Risk of Labor and the Need for Standardization in Out-of-Hospital Settings Even at the lowest possible level of risk, for example, some of the lowrisk deliveries reported in the United Kingdom, labor is, Nigel Paneth said, "one of the most dangerous things that we encounter as human beings." He called for recognition of this reality -- there are risks with labor that need to be addressed.
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From page 143... ...
Brynne Potter added that not only are women who have undisturbed physiologic births unencumbered, but so too are home birth providers. She suggested examining and trying to remove liabilities and other "encumbrances" that make it difficult for hospital physicians to provide home birth–like care.
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From page 144... ...
144 RESEARCH ISSUES IN THE ASSESSMENT OF BIRTH SETTINGS births, why not make them safer? She suggested licensing midwives, standardizing training, providing support, and integrating home health care into the health care system such that the same measures of quality are used in both home and hospital settings.
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