Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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2: Research Strategies for Assessing Childbirth Settings
2: Research Strategies for Assessing Childbirth Settings
Pages 32-44
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From page 32... ...
Whatever design is used, the committee believes that assessaent of the safety and efficacy of birth settings should receive priority in research. Also iaportant is an assessaent of the psychological benefits of one birth setting versus another.
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From page 33... ...
The aoat common types of descriptive studies in maternity care are baaed on collections of vital statistics undertaken by federal and state health agencies. These vital statistics are important in documenting trends and in supplying ideas for further investigations.
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From page 34... ...
. Comparison Groups Birth weight 23 Less than 2.5 kgr greater than 2.5 kg Social class 5 Unsupported mothersr social class 1 Age of mother 2 35+r 20-24 Parity 2 4+~ 1 ~tio of perinatal mortality rates by extremes of values within variables.
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From page 35... ...
For example, randomized clinical trials have been conducted to examine the effect of such variables as the position of the mother during delivery (Humphrey et al., 1973) , the presence of a supportive lay person during delivery (Sosa et al., 1980)
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From page 36... ...
Prospective studies using carefully matched groups of women who deliver in different settings could be used for assessing birth settings. Both selection bias and bias in obtaining information would need to be considered by researchers when matching groups of women.
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From page 37... ...
Similarly, vital statistics data can be used to obtain counts of maternal deaths. When combined, these two frequencies can be used to obtain maternal mortality rates associated with abortions of different kinds, at different gestations, etc.
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From page 38... ...
A convenient and practical way of classifying adverse events is by three categories of data that document the events: adverse events documentable through vital statistics data alone, adverse events requiring the collection of special data, and adverse events whose definitions are based on expert opinion. Use of Vital Statistics The routine recording of births and deaths in all states of the United States can serve as a useful starting point for analysis of risks to mothers and infants as mediated by place of delivery and care provider.
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From page 39... ...
Collection of Relevant Special Data The limitations of vital statistics data argue for considering procedures for systematically obtaining data on the circumstances of delivery and the postnatal complications of mothers and children. Birth certificates are completed as close to the time of birth as possible, and later morbidity data for mother or child cannot be obtained from such a source.
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From page 40... ...
Direct calculation of rates requires data on the total number of deliveries from which these adverse events arise, i.e., data on the denominator population. As discussed in Chapter 1, available vital statistics do not give a reliable count of the number of deliveries in the different delivery schemes because state birth certificates generally do not contain provision for place of intended delivery.
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From page 41... ...
Because of continued controversy and the growing number of different birth settings, the safety and efficacy of these settings is a high-priority matter for research. Recommended research designs or methods for collecting data include randomized clinical trials wherever possible, matched groups or cohort studies of low-risk women delivering in different settings, and surveillance of live births and their complications together with special data collection and methods for evaluating adverse events.
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From page 42... ...
1978. Assessment of surveillance and vital statistics data for monitoring abortion mortality, United States, 1972-1975.
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From page 43... ...
198lb. Assessing clinical trials -- design II.
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From page 44... ...
1979. Cesarean section, fetal monitoring, and perinatal mortality in california.
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