Home Birth in the US: data-driven safety improvements

美国在家分娩：数据驱动的安全改进

基本信息

批准号：
9923692
负责人：
Marit L Bovbjerg
金额：
$ 7.42万
依托单位：
OREGON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9923692
关键词：
Accounting Address Admission activity Affect American College of Obstetricians and Gynecologists Biometry Birth Birth Place Birthing Centers Caring Catchment Area Cause of Death Cesarean section Cessation of life Child Communities Conscious Credentialing Data Data Set Death Rate Discipline of obstetrics Epidemiology Ethics Excess Mortality Family Policy Fetal Death Future Health Policy Health Services Research Healthcare Systems Hemorrhage Home environment Hospitalization Hospitals Infant Mortality Intervention Interview Knowledge Location Logistic Regressions Maternal and Child Health Meconium Aspiration Medical Records Methods Midwife Midwifery Modification National Institute of Child Health and Human Development Neonatal North America Nurse Midwives Outcome Patients Perinatal Personal Satisfaction Policies Policy Maker Positioning Attribute Postpartum Period Pregnancy Process Professional Organizations Provider Public Health Qualitative Research Registries Reporting Reproductive Process Research Methodology Risk Safety Secondary to Sepsis System Systems Integration Training Transcript Trauma Woman Work adverse outcome base child bearing community planning community setting cost cost effective demographics economic evaluation evidence base fetal improved insight intrapartum maternal morbidity maternal outcome maternal risk neonatal death neonatal outcome patient population postpartum care prenatal reproductive tract respiratory distress syndrome statistics stem

项目摘要

Community (home or birth center) births in the US are on the rise, despite major concerns about home birth safety and frank opposition from ACOG. All available evidence suggests that maternal morbidity is substantially reduced in community settings; however, reports of increased rates of fetal/neonatal death, particularly among home births, are prevalent. Nonetheless, recent economic analyses have suggested that community births are substantially more cost effective, even given an increase in fetal/neonatal adverse outcomes. Given the current level of unsustainable maternity care spending in the US, it is vital that we understand the nuances of community—and particularly, home—birth safety in the US, as community birth may well be a component of future cost-conscious maternity care policies. This project will use a pre-existing, de-identified, medical records-based community birth registry to (1) compare maternal and fetal/neonatal outcomes for planned home vs. planned birth center births in the US, and (2) describe circumstances under which excess fetal and neonatal deaths accrue among planned community births. For Aim 1, n > 80,000 planned home and birth center births will be compared on a variety of maternal and fetal/neonatal outcomes using logistic regression, adjusting for differences in patient populations. Maternal outcomes will include intrapartum transfer to a hospital, cesarean, genital tract trauma, hemorrhage, postpartum transfer to a hospital, and hospitalization in the first 6 weeks. Fetal/neonatal outcomes will include intrapartum death, 5-minute Apgar, meconium aspiration syndrome, respiratory distress syndrome, sepsis, neonatal transfer to a hospital, NICU admission, hospitalization in the first 6 weeks, and neonatal death. It is anticipated that effect modification by midwife credential (certified nurse midwife vs. certified professional midwife) might be observed, in which case stratified results would be presented. A mixed-methods approach will be used for Aim 2, combining the medical records data with transcripts from n = 398 Fetal Infant Mortality Review (FIMR) midwife interviews, allowing unique and necessary insights into not only patient-level variables but also practice- and systems-level variables that may be contributing to excessive intrapartum and neonatal deaths among US home births. Given that the number of US women choosing home birth has increased by >70% in the last 10 years, it is imperative that we make all birth locations as safe as possible. The proposed project will provide evidence regarding two key lingering questions about home birth in the US: namely, whether there are differences between home and birth center (and whether those are driven by risk level, place, or midwife training/credentials), and where, how, and why excess mortality is currently observed among women planning community births. This evidence will then inform future maternity care policy, and will be used by clinicians, payers, and patients to make evidence-informed place of birth decisions.

美国的社区（家庭或出生中心）出生在上升，目的地主要关注家庭的关注点生日安全和ACOG的弗兰克反对派。所有可用证据表明，母校发病率是在社区环境中大大减少；但是，关于胎儿/新生儿死亡率增加的报道，特别是在家庭分娩中，很普遍。尽管如此，最近的经济分析表明即使胎儿/新生儿有所增加，社区的出生也更具成本效益不利的结果。考虑到当前美国不可持续的产妇护理支出水平，这是至关重要的我们了解美国社区的细微差别，尤其是在美国的家庭安全，因为社区出生很可能是未来注重成本意识的产妇护理政策的一部分。这个项目将使用先前存在的，取消识别的，基于病历的社区出生注册表与（1）比较计划中的房屋与计划的出生中心出生的母亲和胎儿/新生儿结果，（2）描述计划中过多的胎儿和新生儿死亡的情况社区出生。对于AIM 1，将在A中比较n> 80,000个计划的房屋和出生中心出生。使用逻辑回归的孕产妇和胎儿/新生儿结局的多种多样，调整了差异患者人群。孕产妇的结局将包括原始内部转移到医院，剖宫产，生殖器在最初的6周内，道的创伤，出血，产后转移到医院以及住院。胎儿/新生儿结局将包括原始死亡，5分钟的APGAR，胎粪吸入综合征，呼吸窘迫综合征，败血症，新生儿转移到医院，NICU入院，住院前6周和新生儿死亡。预计助产士证书的效果修改（认证的护士助产士与经认证的专业助产士）可以观察到，在这种情况下进行分层结果将被提出。混合方法方法将用于AIM 2，结合了医学记录来自n = 398胎儿婴儿死亡率审查（FIMR）助产士访谈的成绩单的数据，不仅可以对患者级变量，还可以练习和练习和系统级变量可能导致过多的产前和新生儿死亡我们的家庭出生。鉴于我们选择家庭分娩的女性人数在最近10年，我们必须使所有出生地点尽可能安全。拟议的项目将提供有关美国关于家庭分娩的两个关键问题的证据：即，是否家庭和出生中心之间存在差异（以及这些中心是否是由风险水平，地点驱动的或助产士培训/证书），以及目前在哪里，如何以及为什么在哪里观察到超过死亡率计划社区分娩的妇女。然后，这些证据将为未来的产妇护理政策提供信息，并将由临床医生，付款人和患者使用，以做出证据的出生决策。