Research Issues in the Assessment of Birth Settings: Report of a Study

The Institute of Medicine (IOM) of the National Academy of Sciences (NAS) collaborated in this study with the Board on Maternal, Child, and Family Health Research of the Commission on Life Sciences of the National Research Council (NRC) to determine methodologies needed to evaluate current childbirth settings in the United States. Although the proportion of non-hospital births runs as high as 4.4 percent annually in Oregon, insufficient data exist to permit complete evaluation of the various birth settings. The application of good research methods should lead to scientific findings that provide the basis for informed, rational decision making about alternative settings for childbirth.

A committee of 11 experts was appointed to review current knowledge, provide background knowledge, and identify the kinds of research designs useful for assessing such matters as the safety, quality of maternity care, costs, psychological factors, and family satisfaction of different birth settings. The committee was also charged with preparing a report that could be used to solicit, evaluate, and fund proposals for studies on childbirth settings. The committee did not design specific studies to be carried out, but rather attempted to point out issues that should be considered by researchers because it believed that the best proposals would arise from investigator-initiated research. Gaps in research could be filled by requests for proposals developed by agency staff and the agency peer review committee. In addition, IOM staff members and several consultants provided background papers for the committee's consideration. The research that results from this report will be useful to policymakers and to consumers searching for information to aid in making decisions about birth settings. Research Issues in the Assessment of Birth Settings summarizes the study.

• Front Matter
• Introduction
• Summary and Recommendations
• 1: Basic Concepts and Descriptive Data
• 2: Research Strategies for Assessing Childbirth Settings
• 3: Risk Assessment
• 4: Variables
• Appendix A: Review of the Safety of Maternity Care in Different Birth Locations
• Appendix B : Research Issues Concerning Reimbursement for Childbirth Services
• Appendix C: Freestanding Birth Centers
• Appendix D: Research on Childbirth Settings: The Assessment of Psychological Variables
• Appendix E: Review of Obstetrical Risk Assessment Methods
• Appendix F: Vital Statistics and Nonhospital Births: A Mortality Study of Infants Born Out of Hospitals in Oregon Between 1975 and 1979