TABLE 1.
Outcome Variable Definitions for the 2 Datasets, the MANAStats Project, and the American Association of Birth Centers’ PDR
| Variable name | MANAStats | PDR |
|---|---|---|
| Process outcomes | ||
| Intrapartum transfer | Any transfer of care to a hospital after labor onset but before the baby is born | Any transfer of care to a hospital after labor onset but before the baby is born. The main analysis includes individuals who were never admitted to community birth care in labor but rather transferred to a hospital after the midwife’s first intrapartum assessment |
| Cesarean | Surgical abdominal birth; would only occur after intrapartum transfer | Surgical abdominal birth would only occur after intrapartum transfer |
| Postpartum transfer | Any transfer of care to a hospital during the first 6 h after the baby is born, for a maternal indication. Women who accompany their neonates to the hospital but do not require hospital-level care or resources themselves are not considered postpartum transfers | Risk factor is identified during postpartum, requiring referral to acute care. Not an emergency situation—transport time is not a significant factor. Women who accompany their neonates to the hospital but do not require hospital-level care or resources themselves are not considered postpartum transfers |
| Neonatal transfer | Any transfer of care to a hospital during the first 6 h after the baby is born, for a neonatal indication. Neonates who accompany their mothers to the hospital but do not require hospital-level care or resources themselves are not considered neonatal transfers | Newborn risk factor is identified, which requires referral to acute care setting. Not an emergency—transport time is not a significant factor. Neonates who accompany their mothers to the hospital but do not require hospital-level care or resources themselves are not considered neonatal transfers |
| Maternal health outcomes | ||
| Urgent intrapartum transfer | Midwife considered the intrapartum transfer “urgent” | Risk factor is identified in labor which requires transfer to acute care setting. Situation is urgent and rapid transport is required. Basic emergency treatment may be instituted at the birth center (or mother’s home) |
| Hemorrhage | >1000 mL estimated blood loss | Cumulative blood loss of ≥1000 mL or blood loss accompanied by signs/symptoms of hypovolemia within 24 h after the birth process (includes intrapartum loss) |
| Urgent postpartum transfer | Midwife considered the postpartum transfer “urgent” | Emergency postpartum transfer—Risk factor during postpartum which requires transfer to acute care setting. Situation is urgent and rapid transport time is required. Basic emergency treatment is initiated at the birth center (or mother’s home) |
| Maternal hospitalization | Any maternal hospitalization in the first 6 wk postpartum; does not include postpartum transfers who were in ED only (eg, suturing complex tears without being admitted to an inpatient ward) | Maternal readmission before 6 wk |
| Neonatal health outcomes | ||
| Urgent neonatal transfer | Midwife considered the neonatal transfer “urgent” | Emergency newborn transfer— Newborn risk factor is identified, which requires transport to acute care setting. Situation is urgent and rapid transport is required. Basic emergency treatment is initiated at the birth center (or mother’s home) |
| Neonatal hospitalization | Any neonatal hospitalization in the first 6 wk; does not include neonatal transfers who were in ED only (eg, for pediatrics assessment of congenital anomalies who were then sent home) | Newborn readmission before 6 wk |
| NICU admission | Any NICU admission in the first 6 wk | Newborn admission to NICU after newborn transfer or hospital birth |
| Intrapartum death | Fetus was alive at the onset of labor and died before birth | IUFD after the onset of labor AND after admission to the birth center for intrapartum care (transfers upon initial assessment would not be included) |
| Neonatal death | Liveborn infant who died during the first 27 complete days | Infant died after birth (in any setting) and before 28 d of age |
ED indicates emergency department; IUFD, intrauterine fetal demise; MANAStats, Midwives Alliance of North America Statistics; NICU, neonatal intensive care unit; PDR, Perinatal Data Registry.