Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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1: Basic Concepts and Descriptive Data
1: Basic Concepts and Descriptive Data
Pages 10-31
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From page 10... ...
The absence of adequate evaluation data has fueled a growing controversy among the various advocates of particular birth settings regarding a whole range of outco.e measures, such as safety, cost, and quality of the childbirth experience. The controversy, OMCB concluded, will abate only with the development of a sound body of data about various aspects of current birth practices, including birthplace.
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From page 11... ...
Midwives with little training attended approximately 50 percent of home birthsr other births were attended by neither physician nor midwife. COntroversies surrounding the quality of midwife services helped to bring public and professional attention to the problema associated with inadequate childbirth practices.
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From page 12... ...
Birth settings vary because of the philosophies and practices of those who control the childbirth environment. 'l'he within-category variation in childbirth practices, providers, and clientele may be as great as or greater than differences between sites.
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From page 13... ...
-- - ............... '' 20 ' ',, ', ,, 1920 1930 1940 1950 1980 1970 1980 YEAR PIGURB 1 Neonatal, Infant, and Maternal Mortality Rates, 1915-1980.
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From page 14... ...
SOURCES: National Center for Health Statistics, 198lar u.s. Department of Commerce, Bureau of the Census, 1975, 1980.
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From page 15... ...
The lesser ability of home birth attendants to deal with complications and the relative lack of emergency backup are considered •ajor disadvantages. Freestanding Birth Centers Freestanding birth centers are facilities separate from hospitals that provide maternity care to those expecting normal childbirths (Bennetts and Lubic, 19821 Lubic, 19801 Lubic and Ernst, 1978)
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From page 16... ...
Tbe National Center for Health Statistics (NCBS) has derived data on birthplaces from state birth certificates and designates place of delivery as •in hospital,• •not in hospital,• or •not specified.• Table 2 shows the number and percent distribution for hospital and nonhospital (including not specified)
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From page 17... ...
Tbe method used by NCBS for classifying hospital and nonhospital births may obscure small shifts in nonhospital births. Por example, births in freestanding birth centers are classified by NCHS as hospital births.
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From page 18... ...
. 1 1The percentage of Mexican Americans is so high because this study included one of the largest freestanding birth centers in the country, and that center primarily serves Mexican Americans.
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From page 19... ...
In 1979 they delivered 98.1 percent of in-hospital births and 34.2 percent of nonhospital births (National Center for Health Statistics, 198lb)
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From page 20... ...
~ey perform deliveries in all types of birth settings, including freestanding birth centers and conventional hospital units. Approximately 2,500 CNMs have been certified since the founding of the American College of Nurse-Midwives in 1955r about 1,800 practiced midwifery in 1980 (American College of Nurse-Midwives, 198lr Rooks et al., 1978)
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From page 21... ...
Table 4 has only one row providing comparative inforaation on trends in maternity care practice• aero•• birth settings. fOr freestanding birth center deliverie• •urveyed by Bennett• (1981)
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From page 22... ...
Senate N • 2,000 deliveries ACOG, U67r 1970 N • 262,000 NCHS, U72r Gordon, 1972r SubcOIIIIlittee in freestandinCJ Procedure 1967 N • 2,060,440 1977 N • 1,300,000 1972 N • 2,800,000 NICRD, 1981 1959-65 N • 55,908 Hearin |
From page 23... ...
Women who deliver in freestanding birth centers appear to have higher rates of breastfeeding. National prevalence data on the practice of breastfeeding is best estimated from the 1965 National Fertility Study (NCBS, 1965)
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From page 24... ...
Level II care should be available at hospitals able to provide all services of Level I plus care for most of the complicated obstetrical difficulties and for certain neonatal illnesses. Level III care should be able to cover all types of obstetrical, fetal, and neonatal probleaa in addition to providing teaching, evaluation, and research services.
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From page 25... ...
Homes, birth rooms in hospitals, and freestanding birth centers are locations associated with alternative settings. Most alternative locations depend upon hospital back-up systems when an emergency arises.
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From page 26... ...
YEAR research into the safety, efficacy, psychosocial value, and costs of the various alternatives is urgently needed. Such research would assist prospective parents to choose the most suitable birth setting and also would provide policymakers with information for making decisions about allocation of resources for maternity care.
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From page 27... ...
IIOURCBt Rational Center for Health Statistics, 198la.
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From page 28... ...
Cbicagoa Aaerican Hospital Association.
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From page 29... ...
1975. A study of 300 elective home births.
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From page 30... ...
Monthly Vital Statistics Report 29(13) : National Center for Health Statistics.
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From page 31... ...
1982. Identifying the sources of the recent decline in perinatal mortality rates in California.
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