Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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Summary and Recommendations
Summary and Recommendations
Pages 2-9
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From page 2... ...
For a number of reaaona, social aa well aa medical, a new interest baa developed in the psychological factors surrounding the birth experience. An increased interest in birth settings other than the conventional hospital one oriented toward treating disease and toward physician management of patients baa also developed.
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From page 3... ...
Advocates of nonhospital births emphasize the contributions toward maternal and neonatal well-being made by increased family support and participation in the birth, minimal medical intervention, and lower costs. Maternity Care Providers Maternity care providers include physicians and a small number of certified nurse midwives.
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From page 4... ...
Observational Approaches The committee believes that there is a lack of good descriptive studies on birth settings, especially alternative settings, and that wellconducted prospective descriptive and observational studies, even if without controls, could improve our understanding of the issues and be useful for generating hypotheses for further study. Experimental Designs Randomized Clinical Trials The committee determined that randomized clinical trials could be used to study many different techniques, or differences in the birth attendants, in similar birth settings.
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From page 5... ...
Prospective Matched Groups Nonrandomized designs are likely to be proposed by researchers studying the impact of alternative birth settings. Although randomized experiments are most desirable for interpreting causal relationships, prospective studies using rigorously matched groups delivering in different settings may provide useful information about the safety and psychological benefits of alternative settings.
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From page 6... ...
case-Control Studies If counts of the denominator populations are not available, and if events to be studied occur infrequently, one recourse is to match adverse events with control births free of adverse outcomes and investigate the circuastances of the pregnancy. Por example, if planned nonhospital deliveries are found more frequently among cases of adverse events than .-eng oontrols, this can be taken as evidence for a differential effect of place of delivery on the adverse event.
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From page 7... ...
Variables ccaaon to moat instruments are demographic and socioeconomic and variables baaed on past pregnancies, past medical history, and present pregnancy. In some of the more recent studies, fetal heart rate and uterine contraction data from electronic monitoring have been included.
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From page 8... ...
Government agencies responsible for designing birth and fetal death certificates should include space for routine recording of the intended and actual site of delivery (e.g., conventional hospital delivery rooa or alternative birth roo., freestanding birth center, planned hoae delivery, accidental nonhoapital delivery) and the precise type of provider (board-certified or certificate-eligible obstetrician, general or faaily practitioner, certified nurse midwife, midwife with no special training, other individual)
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From page 9... ...
• Because of the range of settings and the breadth of questions to be answered, the ca.aittee urges a aultidiaciplinary approach and the for.ation of multidisciplinary teams for research on birth settings. A good research prograa will require a variety of investigators to assure valid screening and selection of a study population and ca.petent handling of the range of settings and the flow of patients across a ayatea of care.
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