By Jonathan Springston, Editor, Relias Media

There are no risk-free settings in which mothers can deliver babies, but with proper access to quality care and steady investments in the workforce, giving birth can be safer in the United States than it is today, according to a broad report compiled by the National Academies of Sciences, Engineering, and Medicine (NASEM).

The report authors found 98.4% of all U.S. mothers choose to give birth in hospitals, although there are those who choose to deliver at home or in birth centers, and that rate is increasing. Regardless, there appear to be pros and cons associated with each setting. The authors noted mothers who choose home or birth centers experience fewer interventions such as labor induction or cesarean birth than women who choose hospitals. However, those who deliver in hospitals are at a slightly lower risk for poor neonatal outcomes and neonatal mortality vs. those who choose birth centers and home settings.

“Women giving birth at home or in birth centers also have lower rates of intervention-related injuries and complications, such as infection or postpartum hemorrhage. The fact that women choosing out-of-hospital birth settings want fewer interventions contributes to these lower rates,” NASEM noted in a press release. “The study also found increases in the risk of neonatal death in home births compared with births in a hospital setting, although the precise magnitude of the difference is difficult to assess given flaws in the underlying data.”

In general, some women reported a gap in expectations of care vs. care delivered. The authors noted women of color, especially Native Americans and African Americans, experience the most problems. “Racism and sexism are foundational drivers of poor outcomes in maternity care,” NASEM noted. “The experiences of women of color … such as intergenerational trauma, marginalization, intolerance, and economic disadvantage, create risk factors for pregnancy and childbirth.”

The report authors recommended improvements to all birth settings, ensuring proper access and choice to all women, and dedicated investments in the maternity workforce. Specifically, the authors suggested integrated care plans to improve home and birth center service, including access to proper licenses, written birth plans, and the presence of well-qualified professionals. In addition to adopting and following national guidelines, hospitals should offer timely, respectful, and appropriate care to all women, according to the report.

Further, the report authors called on expanded investment in the maternal and neonatal workforce, including hiring and training more doulas, maternity nurses, and community health workers.

For more on this report and similar subject matter, please read the latest issues of Contraceptive Technology Update and OB/GYN Clinical Alert.