TABLE 3.
Comparison of Process of Care Outcomes for Women With Low-Risk Pregnancies Planning a Home Birth at the Onset of Labor Versus Low-Risk Individuals Planning a Birth Center Birth
| Variable name | Total sample, n (%) | Planned home births, n (%) | Planned birth center births, n (%) | aOR (95% CI)* |
|---|---|---|---|---|
| Outcome | ||||
| Total sample | ||||
| PDR | 50,043 | 1704 (3.4) | 48,339 (96.6) | — |
| MANAStats | 62,984 | 42,778 (67.9) | 20,206 (32.1) | — |
| Intrapartum transfer—all | ||||
| PDR† | 7647 (15.6) | 116 (7.7) | 7531 (15.8) | 0.63 (0.52–0.77) |
| MANAStats | 7549 (12.0) | 4473 (10.5) | 3076 (15.2) | 0.87 (0.82–0.92) |
| Cesarean | ||||
| PDR | 2330 (4.7) | 69 (4.1) | 2261 (4.7) | 1.32 (1.02–1.70) |
| MANAStats | 2814 (4.5) | 1694 (4.0) | 1120 (5.6) | 0.95 (0.88–1.03) |
| Postpartum transfer—all‡ | ||||
| PDR | 923 (2.2) | 17 (1.3) | 906 (2.3) | 0.63 (0.39–1.02) |
| MANAStats | 1430 (2.3) | 900 (2.1) | 530 (2.6) | 0.86 (0.77–0.96) |
| Neonatal transfer—all‡ § | ||||
| PDR | 958 (2.3) | 17 (1.3) | 941 (2.3) | 0.60 (0.37–0.97) |
| MANAStats | 958 (1.5) | 583 (1.4) | 375 (1.9) | 0.80 (0.70–0.92) |
Process of care outcomes are those for which the ideal incidence is above zero: from a community birth practice, we expect some proportion of laboring persons to require hospital care or resources during or immediately after the birth. Thus transfers are expected. Similarly, some proportion of laboring women will require cesareans, regardless of the planned place of birth. Data are from 2 large community birth data registries in the United States: the Perinatal Data Registry (2012–2019) and MANAStats (20121–2018). Results are from unconditional logistic regression models. All odds ratios are presented as planned homes compared with planned birth centers; an odds ratio <1 means that the outcome is less common among planned home births, and an odds ratio >1 means the outcome is more common among planned home births.
Adjusted for provider credential (certified professional midwife, certified nurse midwife/certified midwife, other), maternal demographics (public insurance, maternal education, maternal race/ethnicity, married/partnered), and pregnancy-related risk factors (advanced maternal age, pre-gravid body mass index, parity).
Women not admitted to community birth care once in labor (ie, immediate intrapartum transfers) were counted as having experienced this outcome. This applies to the PDR data only (see “Methods” section).
Models are limited to no intrapartum transfer, but percentages in the first 3 columns were calculated with the entire sample as the denominator, to be consistent with previous publications using these data.
Models are limited to no known IP death (deaths of unknown timing are retained); denominators for percentages are likewise limited to liveborn infants only.
aOR indicates adjusted odds ratio; IP, intrapartum; MANAStats, Midwives Alliance of North America Statistics; PDR, Perinatal Data Registry.