The U.S. has the highest perinatal (the period a mother becomes pregnant up to a year after giving birth) morbidity and mortality rates of all the high-resource countries. Of the mothers affected, the risk for Hispanic and Black women increases threefold compared to non-Hispanic and White women.

The factors contributing to these rates are complicated, making a solution to reduce this number hard to pinpoint. Previously, studies have focused on a few of these individual factors but not looked at all influencing components as a whole.

Getting a full picture of the problem

A new analysis from Boston College wanted to get the full picture of the situation. They considered data from 23 published stories on the topic which explore decision-making factors impacting choices around birthing.

A key one of these factors is the decision where to give birth: either in birth centers, at home, or in hospitals. Out of 3.61 million annual births in the U.S., over 98 percent occur in a hospital setting, with only 1.99 percent occurring in birth centers and at home. Which setting is chosen impacts rates of intervention and satisfaction with care and health costs. Alternative settings such as birth centers, for instance, actually have a higher rate of satisfaction from mothers, lower costs, and lower instances of intervention, which can increase the chances of complications and harm.

Other influencing factors include family and friends, access to birthing awareness, and access to options (physical and financial). The media also plays a key role, with resources such as the film The Business of Being Born and the book Spiritual Midwifery by Ina May Gaskin, being cited as key resources in sparking interest in home birth and midwifery care.

The future for mothers could be brighter

“Understanding how people decide where to give birth can support informed decision-making about a given birth setting’s ability to fit their needs and affect their experiences and outcomes,” said lead author Erin George.

They continued: “Such research is also necessary to underscore the importance of building a comprehensive system of high-quality perinatal health in the United States that ensures equitable access to all birth settings.”

This study brings to light the stark lack of unbiased information on birthing in hospitals compared to alternative birthing settings. With many regions lacking birth centers and hospital facilities offering perinatal care which is covered by health insurance providers, more data needs to be collected on birthing settings, and mothers and future parents need to do their own research to figure out what works best for them.

From integrative review studies such as this, the U.S. government and medical bodies can more deeply understand where gaps in the midwifery workforce and training programs lie. Through this, access to healthcare and birth setting choices can increase which in turn will lower perinatal morbidity and mortality rates.

Source study: Birth – Factors Influencing Birth Setting Decision-Making in the United States: An Integrative Review