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Birth Settings in America: Outcomes, Quality, Access, and Choice

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Birth Settings in America

Outcomes, Quality, Access, and Choice (2020)
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The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines.

Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.


Suggested Citation

National Academies of Sciences, Engineering, and Medicine. 2020. Birth Settings in America: Outcomes, Quality, Access, and Choice. Washington, DC: The National Academies Press.

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Publication Info

368 pages |6 x 9
  • Paperback: 978-0-309-66982-5
  • Ebook: 978-0-309-66985-6



Learning from the International Experience

What can the U.S. maternity care system learn from the international experience? Drawing lessons from international examples and pockets of high-performing care in the United States, Birth Settings in America identifies ways to improve childbirth services in hospitals, birth centers, and home birth settings.

Understanding Birth Settings in America

Science shows opportunities for improving care across birth settings. Home, birth center, and hospital birth settings each offer risks and benefits to pregnant people and newborns. While no setting is risk free, we can modify risks within each setting and across settings. And, we can make birth safer for all with greater integration throughout the maternity care system.

Improving Access and Choice in Birth Settings

How can we improve pregnant people’s choice and access to the full range of birth settings and types of maternity care providers? Pregnant individuals should be able to make informed decisions about the care they receive during pregnancy. But an individual’s choice in birth setting may be limited by their access to care.

What Providers Need to Know

Childbirth services play a critical role in the provision of health care in the United States, but some pregnant people experience a gap between the care they expect and deserve and the care they need. How can maternity care providers in all settings help reduce this gap?


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