The Association Between Socioeconomic Status and Out-of-Hospital Obstetrical Outcomes

Principal Investigator:  Jill Edwards, ND

BACKGROUND AND SIGNIFICANCE:  More and more women are choosing to give birth out of the hospital.  There has been very little information gathered about the effects of socioeconomic status (SES) on outcomes of out-of-hospital births. Low maternal SES is known to negatively influence hospital birth outcomes. Various prenatal and obstetric care models, such as individualized care and pre and postnatal home visits, have also been to shown to improve birth outcomes among socially disadvantaged women. Many of these models are integrated into midwifery care and thus midwife led out-of-hospital birth has the potential to reduce adverse birth outcomes for these populations.

RESEARCH DESIGN & METHODS: To gain greater insight into the relationship between SES and obstetric outcomes in the out-of-hospital setting, we will compare obstetric outcomes among women of different SES using methods of payment as a proxy.  This will be accomplished by analyzing data about midwifery assisted out-of-hospital births collected by the Midwives Alliance of North America Division of Research.  Method of payment (Medicaid, self-pay, private insurance, and other) will be analyzed for its role as a predictor of the selected outcomes.  Outcome measures include: APGAR scores, neonatal NICU admission, neonatal birth injury, birth weight, meconium staining of amniotic fluid, maternal transfusion, maternal labial and perineal tears, method of delivery, premature rupture of membranes, length of labor, and transfer to high level of care before or after delivery.