Factors Associated With Interest in Birth Center Care for a Future Pregnancy: A Secondary Analysis of the Listening to Mothers in California Survey

Birth · 2025-11-24

BACKGROUND: Understanding future demand for midwifery-led birth centers is critical to increasing utilization of this high-value model of care. This study examines factors associated with interest in birth center care for a future pregnancy. METHODS: We analyzed data from the Listening to Mothers in California survey. The study included 1447 people who had a singleton hospital birth in 2016 and did not have a history of cesarean birth. Multivariate logistic regression models were conducted with variables that were aligned with the Coxon model of birth setting decision-making. RESULTS: More than half of respondents (n = 789; 54.5%) expressed interest in receiving care at a birth center in the future. Respondents were more likely to express interest in birth center care if they had experienced pressure to have an obstetric intervention (AOR 1.86, 95% CI = 1.83-1.90) or believed that birth is a natural process that should not be interfered with unless medically necessary (AOR 1.74, 95% CI = 1.71-1.78), compared to respondents who did not. They were also more likely to have sought information about hospital cesarean rates (AOR 1.50, 95% CI = 1.47-1.52), had a doula in labor (AOR 1.42, 95% CI = 1.39-1.45), and experienced mistreatment (AOR 1.23, 95% CI = 1.21-1.26). CONCLUSIONS: Broadening access to midwifery-led birth centers to accommodate future demand is needed. Providing pregnant people with comparable quality measures of birth center and hospital care may facilitate informed decision-making. Improving the shared decision-making abilities of healthcare providers could help prevent instances of mistreatment or undue pressure on pregnant individuals to undergo obstetrical interventions.

Collection of Perinatal Data in the United States

Journal of Obstetric, Gynecologic & Neonatal Nursing · 2025-06-16 · 3 citations

A systematic review of non-binary measures of pregnancy perceptions, attitudes and reactions, and associated outcomes

BMC Pregnancy and Childbirth · 2025-12-26

“Unintended pregnancy” is a ubiquitous indicator of poor public health, but is highly problematic and limited. A conceptual evolution in pregnancy intention measurement and categorization has led to numerous, often hard-to-compare studies using a multitude of non-binary, multi-dimensional pregnancy measures. Herein we conducted a systematic review of research studying non-binary measures of pregnancy perceptions, attitudes, and reactions, as predictors of public health outcomes. Forty-three articles met inclusion criteria. We summarized existing pregnancy measures, cataloged the dimensions of pregnancy they measure, and tracked significant outcomes associated with these measures. We documented numerous pregnancy-related measures including those on ambivalence, acceptability, timing, intention, emotional response, use of contraception, preparation for pregnancy, opinions/reactions of partners and others, perceived fecundity, readiness, denial, and self-efficacy to prevent pregnancy. The strongest associations with maternal and child health outcomes were observed for depression. Relationships with pregnancy complications and outcomes, postpartum care, breastfeeding, attachment, and child health are very unclear. Temporal confounding precludes many conclusions about psychosocial outcomes. Acknowledging multiple dimensions of and pathways to pregnancy is critical for researchers in public health, clinical care, and the social sciences. Research questions should be clear in their hypothesized relationships and pathways, and specific in their dimensions of interest. New paradigms are needed that move beyond pregnancy planning and intention.

“It's my Home away from Home:” A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care

Midwifery · 2024-08-30 · 3 citations

Placental biomarkers in second trimester maternal serum are associated with postpartum hemorrhage: a secondary analysis of the NuMoM2b dataset

medRxiv · 2024-12-31

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, which is often attributed to retained placenta (RP) after delivery. There are no biomarkers currently used to predict a risk of developing RP/PPH prior to labor. The objective of this study was to determine relationships between placental biomarkers measured in the first and second trimesters and proxy measures of postpartum blood loss relative to preeclampsia status in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset. 2,192 participants had placental analytes drawn during the first and second trimesters (9-13 and 16-22 weeks gestation, respectively); the outcome was a composite of retained placenta and/or PPH requiring blood transfusion (RP/PPH). Using Kruskal-Wallis tests, median differences in levels of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), sFlt-1/PlGF ratio, soluble endoglin (sEng), beta subunit of human chorionic gonadotropin (β-hCG), inhibin A (INHA), and pregnancy-associated protein-A (PAPP-A) were assessed between women with (n=67) and without (n=2125) RP/PPH overall and stratified by preeclampsia status. Women with RP/PPH had significantly higher median levels of sEng, β-hCG, INHA, PAPP-A in the second trimester and sFlt-1was higher in both first and second trimesters, which was observed again when stratifying by preeclampsia status. Our findings indicate that biomarkers associated with angiogenesis, particularly when measured in the second trimester, are important targets for further study of RP and/or PPH pathophysiology and potential risk screening development.

Experiences of Midwives Attending Home Births in Massachusetts During the COVID‐19 Pandemic

Journal of Midwifery & Women s Health · 2023-09-27

INTRODUCTION: Public interest in home birth in the United States increased during the COVID-19 pandemic. Midwives attend the vast majority of home births and are experts in providing home birth care. However, limited data are available about the experiences of midwives attending home births during the pandemic in the United States. METHODS: We developed a cross-sectional survey comprising 34 questions, which included 5 open-ended questions. The survey was distributed online in June 2021 to midwives attending home birth in Massachusetts. We calculated descriptive statistics for the quantitative survey responses and identified qualitative free-text responses illustrating the results. RESULTS: Eighteen midwives and 2 midwife apprentices responded to the survey, approximately 50% of Massachusetts' total number of midwives known to attend homebirths. The majority of the 20 respondents reported an increase in public interest in home birth (n = 17) and higher caseloads (n = 14) since the start of the pandemic. Respondents reported an increase in the number of clients transferring to their practices at a later gestational age (n = 13) and who identified as people of color (n = 8). They described both better and worse transfer of care to hospital experiences. Work-life balance and unpredictable income were the top 2 reported obstacles to home birth practice. DISCUSSION: The results of our study indicate that midwives providing home birth care in Massachusetts witnessed a surge in demand for their services during the pandemic. Implementing policies and practices that provide support for certified professional midwives could strengthen the home birth workforce, enhance access to home birth options, and optimize transfers to hospital settings when necessary.

Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic

Journal of Obstetric, Gynecologic & Neonatal Nursing · 2023-05-10 · 10 citations

Choosing a Birth Setting: A Shared Decision‐Making Approach

Journal of Midwifery & Women s Health · 2022-05-26 · 2 citations

Perinatal outcomes vary widely depending on individual birth settings (birth center, home, and hospital). The purpose of this case study is to explore a patient-centered, shared decision-making approach to achieve an informed, values-based choice about birth settings. Engaging in a shared decision-making approach regarding birth setting options would support people to have the information and ability to judge for themselves how benefits and risks across birth center, home, and hospital settings would best fit with their values and personal health. A patient decision aid about birth setting options could facilitate increased equity regarding access to birth settings that offer improved perinatal health outcomes, helping to reduce perinatal health disparities in the United States.

Factors influencing birth setting <scp>decision making</scp> in the United States: An integrative review

Birth · 2022-04-20 · 11 citations

BACKGROUND: The United States has the highest perinatal morbidity and mortality (M&M) rates among all high-resource countries in the world. Birth settings (birth center, home, or hospital) influence clinical outcomes, experience of care, and health care costs. Increasing use of low-intervention birth settings can reduce perinatal M&M. This integrative review evaluated factors influencing birth setting decision making among women and birthing people in the United States. METHODS: A search strategy was implemented within the CINAHL, PubMed, PsycInfo, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the review, and the Johns Hopkins Nursing Evidence-Based Practice model was used to evaluate methodological quality and appraisal of the evidence. The Whittemore and Knafl integrative review framework informed the extraction and analysis of the data and generation of findings. RESULTS: We identified 23 articles that met inclusion criteria. Four analytical themes were generated that described factors that influence birth setting decision making in the United States: "Birth Setting Safety vs. Risk," "Influence of Media, Family, and Friends on Birth Setting Awareness," "Presence or Absence of Choice and Control," and "Access to Options." DISCUSSION: Supporting women and birthing people to make informed decisions by providing information about birth setting options and variations in models of care by birth setting is a critical patient-centered strategy to ensure equitable access to low-intervention birth settings. Policies that expand affordable health insurance to cover midwifery care in all birth settings are needed to enable people to make informed choices about birth location that align with their values, individual pregnancy characteristics, and preferences.

Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic

Journal of Obstetric, Gynecologic & Neonatal Nursing · 2022-07-01 · 2 citations