More than 30 years ago, the Institute of Medicine (IOM) and the National Research Council (NRC) convened a committee to determine methodologies and research needed to evaluate childbirth settings in the United States. The committee members reported their findings and recommendations in a consensus report, Research Issues in the Assessment of Birth Settings (IOM and NRC, 1982). An Update on Research Issues in the Assessment of Birth Settings is the summary of a workshop convened in March, 2013, to review updates to the 1982 report. Health care providers, researchers, government officials, and other experts from midwifery, nursing, obstetric medicine, neonatal medicine, public health, social science, and related fields presented and discussed research findings that advance our understanding of the effects of maternal care services in different birth settings on labor, clinical and other birth procedures, and birth outcomes. These settings include conventional hospital labor and delivery wards, birth centers, and home births. This report identifies datasets and relevant research literature that may inform a future ad hoc consensus study to address these concerns.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE ON RESEARCH ISSUES IN THE ASSESSMENT OF BIRTH SETTINGS: A WORKSHOP
• Reviewers
• 1. Introduction
  • MAJOR WORKSHOP THEMES
  • ABOUT THIS REPORT
• 2. Context and Background
  • HISTORICAL AND RECENT TRENDS IN CHILDBIRTH IN THE UNITED STATES
  • WHO ARE THE WOMEN GIVING BIRTH IN VARIOUS SETTINGS?
  • BIRTH SETTINGS: ANYTHING NEW SINCE '82
• 3. Assessment of Risk in Pregnancy
  • IDENTIFYING LOW-RISK PREGNANCIES
  • SOCIOLOGICAL PERSPECTIVE ON RISK ASSESSMENT IN PREGNANCY
  • PRESENTATION ON ASSESSMENT OF RISK IN PREGNANCY
  • DISCUSSION WITH THE AUDIENCE
• 4. Birth Settings and Health Outcomes: State of the Science
  • COCHRANE REVIEW OF ALTERNATIVE VERSUS CONVENTIONAL INSTITUTIONAL SETTINGS FOR BIRTH
  • BIRTHPLACE IN ENGLAND COLLABORATIVE GROUP STUDIES
  • PROCESS OF CARE DURING CHILDBIRTH
  • EFFECT OF BUILT ENVIRONMENT ON THE NEUROENDOCRINE IMMUNE AXIS AND HEALTH: IMPLICATIONS FOR DESIGN OF HOSPITAL BIRTHING ENVIRONMENTS
  • BIRTH SETTINGS AND HEALTH OUTCOMES: STATE OF THE SCIENCE
  • DISCUSSION WITH THE AUDIENCE
• 5. Workforce Issues
  • EDUCATION, REGULATION, AND MANAGEMENT OF HEALTH CARE PROFESSIONALS IN BIRTH SETTINGS
  • PERINATAL RN STAFFING IN BIRTH SETTINGS
  • RESEARCH ISSUES IN THE ASSESSMENT OF BIRTH SETTINGS: WORKFORCE ISSUES
  • DISCUSSION WITH THE AUDIENCE
• 6. Data Systems and Measurement
  • THE USE OF DATA FOR DECISION MAKING: BIRTH SETTING
  • STRONG START: APPROACHES TO DATA COLLECTION AND EVALUATION
  • DATA SYSTEMS AND MEASUREMENT: FORMAL DISCUSSION
  • DISCUSSION WITH THE AUDIENCE
• 7. Costs, Values, and Reimbursement Issues Associated with Various Birth Settings
  • REIMBURSEMENT ISSUES AND PAYMENT INNOVATION
  • ASSESSING COSTS OF BIRTHS IN VARIED SETTINGS
  • COST, VALUE, AND REIMBURSEMENT ISSUES: THE MEDICAID PERSPECTIVE
  • DISCUSSION WITH THE AUDIENCE
• 8. Perspective from Providers
  • NEONATAL OUTCOMES IN RELATION TO BIRTH LOCATION: ETHICAL IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH
  • RESEARCH ISSUES PERTAINING TO BIRTH CENTERS: A PROVIDER'S PERSPECTIVE
  • PROVIDER PERSPECTIVES: MIDWIVES AND HOME BIRTH
  • DISCUSSION WITH THE AUDIENCE
• 9. Workshop Reflections: Moving the Research Agenda Forward
  • CONSIDERATIONS WHEN EVALUATING STUDIES ON BIRTH SETTINGS
  • REFLECTIONS ON WORKSHOP AND FUTURE RESEARCH NEEDS
  • CLOSING REMARKS
• References
• APPENDIXES
  • A Workshop Agenda
  • B Moderator and Speaker Biographical Sketches
  • C Abbreviations and Acronyms

Rapporteur: Leslie Pray.

This activity was supported by Grant No. P3020147 between the National Academy of Sciences and the W.K. Kellogg Foundation. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

Suggested citation:

IOM (Institute of Medicine) and NRC (National Research Council). 2013. An update on research issues in the assessment of birth settings: Workshop summary. Washington, DC: The National Academies Press.

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.