An Update on Research Issues in the Assessment of Birth Settings Workshop Summary (2013) / Chapter Skim
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6 Data Systems and Measurement
6 Data Systems and Measurement
Pages 93-114
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From page 93... ...
use of birth setting data to articulate its planned home birth committee opinion (ACOG, 2011)
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From page 94... ...
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.
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From page 95... ...
As more data were collected, Barth said, "the tides began to change." Several studies appeared showing that neonatal deaths and other newborn outcomes associated with planned home births are no different than those associated with hospital births. These include a retrospective cohort study conducted in Sweden and based on data collected from the Swedish medical birth register and from follow-up phone calls (Lindgren et al., 2008)
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(2010) was the twofold increase in neonatal deaths and almost threefold increase in nonanomalous deaths among planned home births compared to hospital births.
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Thus, the ACOG committee on obstetric practice went forward with its committee opinion on planned home births and included in its opinion a statement on the twofold to threefold increased risk of neonatal death among planned home births when compared with planned hospital births. Barth emphasized that the committee opinion is the opinion of an organization, not the opinion of an individual, and that the emphasis on the increased risk of neonatal death among planned home births is an organizational opinion.
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standard certificate of live birth does not do. It does not capture planned home births transferred to hospitals.
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Other data sources include various national perinatal data collection efforts (e.g., efforts by the University Health Consortium and National Perinatal Information Center) , states' perinatal reporting beyond birth certificates (e.g., the California Maternal Quality Care Collaborative)
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One of the approaches is being evaluated through the Maternal, Infant, and Early Childhood Home Visiting program, a Health Resources and Services Administration project with a mandate from the Affordable Care Act to measure home visiting. Strong Start is looking at a component of the Mother and Infant Home Visiting Program Evaluation (MIHOPE)
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However, the midwife in attendance may not necessarily be one that a woman has seen much throughout prenatal care. As with providers, birth settings vary among the three different care models.
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The same is true of birth centers and group prenatal care. In order to capture as much of this variation as possible, Strong Start II is using a multipronged evaluation approach.
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Although gestational age and birth weight are usually recorded relatively accurately, many other fields are not consistently recorded. These include risk factors of relevance to preterm births (e.g., having a prior preterm birth)
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For example, is it acceptable to care for a woman with preeclampsia, gestational diabetes, and a prior preterm birth at a birth center as opposed to a maternity care home? Are the same risk profiles distributed equally among the three interventions?
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Challenges to Evaluating Birth Setting Data Main discussed several challenges to evaluating birth setting data that earlier presenters had mentioned: limitations of vital records, denominator and numerator size issues, power limitations, comparison issues, and identification of high risk factors. Limitations of Vital Records The U.S.
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From page 106... ...
(2013) comparing three different ways of analyzing hospital versus planned home birth data from Oregon to illustrate denominator and numerator data limitation issues.
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(2013) analysis involved only 2,736 home births, with 7 neonatal deaths, which amounts to a 0.26 percent neonatal death rate, similar to that for total hospital births.
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This is true across most typically analyzed labor outcomes (e.g., Cesarean birth rates, labor length, labor pain, physiological birth rates, and successful birthing center or home births)
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However, while PDDs are submitted by every hospital to a central state agency, they are not collected for home births or freestanding birth center births. Voluntary data sources include registries and research datasets.
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As another example, the California Maternal Data Center is a statewide data center that links birth certificate data provided by the state (every 45 days) and hospital-supplied PDD or International Classification of Diseases, 9th revision (ICD-9)
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She expressed concern that the notion of absolute risk is "underutilized." William Barth explained that the difference in the denominators resulted from a decision to include neonatal mortality data only for those studies that extended out to 28 days. He emphasized that the authors of the ACOG committee opinion on planned home births tried to be very careful with their words by differentiating between relative and absolute risk.
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From page 112... ...
First, Cross-Barnet clarified that Strong Start collects data only for birth centers, maternity care homes, and centering/group care. The program does not collect data for home births, even though Medicaid pays for home births in some states.
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From page 113... ...
Nor does using the word "versus," as in "hospital births versus home births" help the discussion. Another workshop participant suggested that "standard" be used instead of "traditional." A Woman's Choice of Birth Setting A comment was made in response to one of William Barth's quotes.
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