The impact of birth settings on pregnancy outcomes in the United States

Grünebaum, Amos; Bornstein, Eran; McLeod-Sordjan, Renee; Lewis, Tricia; Wasden, Shane W.; Combs, Adriann; Katz, Alvin; Klein, Roman; Warman, Ashley J.; Black, Alex A.; Chervenak, Frank A.

doi:10.1016/j.ajog.2022.08.011

Cited by 10 publications

(4 citation statements)

References 63 publications

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“…This study further investigates the relationship between the professional characteristics of midwives and their engagement in restrictive episiotomy practices. A significant finding is that midwives who attend home births, known for their training and familiarity with minimal intervention during childbirth, exhibit a particularly restrictive approach to episiotomy in these typically low-risk settings, as supported by the literature (Grünebaum et al, 2023). Another determinant of restrictive episiotomy practices is employment within a teaching hospital environment, where there exists an enhanced commitment to adhering to established guidelines.…”

Section: Factors Influencing the Adoption Of Restrictive Episiotomy P...mentioning

confidence: 94%

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Laderas Díaz,

Rodríguez‐Almagro,

Picón Rodríguez

et al. 2024

Nursing Open

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AimDifferent clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy.DesignObservational cross‐sectional study.MethodsThree hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated.ResultsIntrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first‐degree tears and 273 (89.5%) always sutured second‐degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69–15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39–9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46–8.79) were significantly more likely to adopt a restrictive use of episiotomy.ConclusionsThere is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training.Patient or Public ContributionNo patient or public contribution.

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Section: Factors Influencing the Adoption Of Restrictive Episiotomy P...mentioning

confidence: 94%

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Laderas Díaz,

Rodríguez‐Almagro,

Picón Rodríguez

et al. 2024

Nursing Open

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“…Aragon et al found that the process of developing a birth plan could be very educational; women learned about their options and hospital policy and were given a formal opportunity to address their concerns [28]. [30]. However, what was not mentioned in that checklist were the ideas of women seeking control, advice and support, and the influence of personal stories that were found through this social media search.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the uneven training of midwives attending home births in the US must be addressed. More than two-thirds of certified professional midwives (CPM) attending home births in the US do not meet minimum education standards, and at least 30% of those births are not low risk and do not meet clinical criteria set by ACOG and AAP [30,31]. The American College of Nurse Midwives lays out standards for education, which meet global guidelines from the International Confederation of Midwives, for Certified Nurse Midwives (CNM) and Certified Midwives (CM).…”

Section: Discussionmentioning

confidence: 99%

How Do Women Vote: What Women Post About Home Birth Versus Hospital Birth on Popular Social Media Platforms

Morris,

Lane,

Nelson

et al. 2024

Cureus

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Introduction: The rates of home birth have been increasing; reliance on social media as a source of medical advice and support for patients has also been increasing. This is the first study that directly evaluates birthing people’s perceptions, attitudes, and advice about planned home births expressed in public posts and comments on two popular social media platforms - Reddit and TikTok. Methods: Posts on each platform were searched from January 2017 through July 2022 using the terms “home birth” and “home vs. hospital birth”. Included posts were from the United States written in English, with at least 10 comments and 10 upvotes or likes. Up to five themes were collected per post or comment and were categorized as supportive, opposing, or neutral. The Institutional Review Board (IRB) determined that the project did not include human subjects. Results: Collectively, 777 posts and 47,452 comments were evaluated for inclusion; 257 posts and 2,408 comments met the inclusion criteria for analysis. In posts, 69% supported, 20% opposed, and 11% were neutral toward home birth (n = 257). Similarly, in comments, 53% supported, 28% opposed, and 19% were neutral (n = 2,408). Supportive themes included concerns about the safety of hospital delivery and reassurance about home birth safety, enhanced patient control with home deliveries, positive personal stories reinforcing home birth, concerns about excessive interventions in hospital birth, and advice about preparing for home birth. Opposing themes included concerns about risks of home birth, negligence of those attempting it, reassurance that hospital birth does offer women control, greater financial costs of home birth and that medical interventions can be lifesaving. Conclusion: These results can help physicians recognize some of the women’s concerns about hospital births and what information they may find on social media guiding them as they formulate their birth plans. Overall, this information helps with the goal of balancing patient safety with the need to respect patient autonomy.

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“…In 2021, there were 3,664,292 births in the United States. Of those birth, 98.3% took place in hospitals [ 1 ]. In hospital settings, medical interventions such as induction of labor, cesarean sections, and the use of instruments like forceps or vacuum extractors may be more common [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Sacred space: a qualitative interpretive meta-synthesis of women’s experiences of supportive birthing environments

Maxwell,

Leat,

Gallegos

et al. 2024

BMC Pregnancy Childbirth

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Background In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers. Method This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother’s experiences of environmental factors contributing to a supportive birthing environment within healthcare settings? Results Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment. Conclusions Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.

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The impact of birth settings on pregnancy outcomes in the United States

Cited by 10 publications

References 63 publications

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain

How Do Women Vote: What Women Post About Home Birth Versus Hospital Birth on Popular Social Media Platforms

Sacred space: a qualitative interpretive meta-synthesis of women’s experiences of supportive birthing environments

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