Birth Settings in the U.S.

LOCATION, LOCATION, LOCATION: BIRTH SETTINGS IN THE US. Pregnant women and their families have a decision to make when it comes to where to give birth. While hospitals are the most common choice, many women choose to have their babies outside of traditional hospital settings. What do you know about the options? WHERE DO PEOPLE GIVE BIRTH? Nearly 4 million births occur in the United States every year. 98.8% happen in a hospital 1.2% happen out-of-hospital OF THOSE BIRTHS THAT HAPPEN OUT-OF-HOSPITAL: 67% 28% 5% 98.8% Birth Center Home Other Hospital HOW COMMON ARE BIRTH CENTERS? A birth center is a home-like setting-primarily located outside of a hospital-where care providers, usually midwives, provide family-centered care to healthy pregnant women. THE NUMBER OF BIRTH CENTERS HAS GROWN IN RECENT YEARS 250 200 150 100 1984 1994 2004 2011 WHAT ARE THE RISK FACTORS? WHAT MAKES FOR A WHAT COMPLICATIONS CAN HIGH-RISK PREGNANCY? OCCUR DURING LABOR? Having a previous premature birth Prolapsed umbilical cord: the umbilical cord delivers before the baby, which Pregnancy with twins, triplets or other multiples requires emergency action Conceiving through in vitro fertilization Lack of progress in delivery Problems with the uterus, cervix or placenta Hemorrhage Smoking cigarettes, drinking alcohol or using illicit drugs Fetal distress Some infections, particularly of the Umbilical cord wrapped around amniotic fluid and lower genital tract baby's neck Some chronic conditions,such as high blood pressure and diabetes *Defined by BMI and specified in the IOM/NRC report Weight Gain During Pregnancy: Reexamining the Guidelines Being underweight or overweight before pregnancy* Multiple miscarriages or abortions Unusual shape of the uterus WHAT DO LABOR AND DELIVERY COST? The costs incurred for childbirth depend not only on the birth setting, but also on the type of delivery (vaginal or cesarean) and any complications that may arise during labor. BIRTH CENTER $2,277 HOSPITAL* $8,920 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K "This does not account for costs arising from complicated births. WHY DO PEOPLE CHOOSE OUT-OF-HOSPITAL BIRTHS? - 100 MI Cultural or Surrounded Desire for low- intervention birth Inability to get to a hospital Cost religious reasons by family WHO DELIVERS BABIES? Non-CNM/CM Midwives CNM/CM Physician Other (including CPMS) 4.8% 3% BIRTH 51.4% 40.8% CENTER 4.3% НОМЕ 20.6% 43.6% 31.5% 0.4% HOSPITAL 7.3% 92.3% 0% 20% 40% 60% 80% 100% CNM (CERTIFIED NURSE MIDWIFE) OB/GYN (OBSTETRICIAN/GYNECOLOGIST) A physician who has received an advanced medical degree, completed a residency in obstetrics and gynecology and is certified by the American Board of Obstetrics and Gynecology. A nurse and midwife who has received an advanced degree and preparation from a nurse-midwifery education program that has been accredited by the American Commission for Midwifery Education (ACME) and is certified by the American Midwifery Certification Board (AMCB). CPM (CERTIFIED PROFESSIONAL MIDWIFE) CM (CERTIFIED MIDWIFE) A midwife who has received an advanced degree and preparation from a midwifery education program that has been accredited by the ACME and is certified by the AMCB. A midwife who has been certified by the North American Registry of Midwives (NARM). There is no degree requirement. Some CPMS have completed a midwifery education program accredited by the Midwifery Education Accreditation Council. Others complete a Portfolio Evaluation Process through NARM. For more information, visit www.iom.edu/birthsettingsWs SOURCES: Locations/Birth Centers: http://www.birthcenters.org/webfm_send/113 Risk factors: www.mayoclinic.com/health/premature-birth/DSO0137/DSECTION»risk-factors; www.home-birth-guide.com/home-birth-risk.html Cost: http://www.birthcenters.org/webfm_send/113; http://transform.childbirthconnection.org/resources/datacenter/chargeschart/ Choice: MacDorman, Marian F., et al. "Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006." National Vital Statistics Report. 58.11 (2010). Providers: MacDorman, Marian F. Unpublished data from the 2010 natality data file;www.medterms.com/script/main/art.asp?articlekey-4609; http://www.midwife.org/ACNM/ les/ccLibraryFiles/Filename/000000001385/CNM%20CM%20 CPM%20ComparisonChart%20082511.pdf INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES # of birth centers in the U.S.