1. Conclusion & Nursing Implications
A Community Assessment of Birth Preferences and Options for Low Risk Women in the Seacoast of New Hampshire
Claire Martindale, Senior Nursing Major, Honors in Major
University of New Hampshire Nursing Department, Durham NH
Introduction
There are many birth places and providers available to women but the accessibility of and desire for these options is unknown in the Seacoast of NH. Additionally, some options provide better outcomes than others.
Background
Healthy People 2020’s goals:
Decreased neonatal mortality rate 15
Decrease maternal cesarean section rate 15
Birthplaces
Hospital: Most common
Freestanding Birth Center: Safe option, equal neonatal mortality, other neonatal benefits, decreased cesarean section rate 1,14
Home: Increased neonatal mortality rate, lower 5 min APGARs, decreased cesarean section rate, some evidence to support safety in US. 4,8
Birth Providers:
OBGYN: Most common
Certified Nurse Midwife: Safe alternative, equal neonatal mortality, decreased cesarean section rate 2,9
Certified Professional Midwife/NH Certified Midwife: Little evidence in the US
Unassisted: No research on outcomes found
Limitations
Very limited sample size
Mostly high socioeconomic, may not be representative
Methods
Evidence Based qualtrics Survey on an online mothers support group
Snowball recruitment method
Descriptive Statistics
Conclusion & Nursing Implications
No freestanding birth centers in the Seacoast
Further research with a larger sample size
Consider supporting a freestanding birth center
More use of CNMs for low risk women
Promote education on safe birth options in US
Population
Women who live in the Seacoast of NH, ages 18 – 39 of all socioeconomic status, who met the following health criteria: Less than 40 years old, pre-pregnancy BMI < 30, no HTN, DM, syphilis, hepatitis B or hepatitis C before or during pregnancy, singleton pregnancy, vertex presentation, no fetal congenital abnormalities, delivery between 37 – 42 weeks gestation 7
Results
Acknowledgments
Dr. Joyce Cappiello PhD, FNP, FAANP
Dr. Joanne Samuels PhD, RN, CNL
References
(1) Alliman, J., Phillippi, J. C. (2016). Maternal outcomes in birth centers: An integrative review of the literature. Journal of Midwifery and Women’s Health. Retrieved from:
(2) Carlson, N. S., Corwin, E. J., Hernandez, T. L., Holt, E., Lowe, N. K., & Hurt, K. J. (2018). Association between provider type and cesarean birth in healthy nulliparous laboring women: A retrospective cohort study. Birth: Issues in Perinatal Care, 45(2), 159–168.
(4) Cheyney, M., Bevjberg, M. L. & Bucher, P. (2015). Safe for whom? BJOB Debate. Retrieved from
(7) Danilack, V. A., Nunes, A. P., & Phipps, M. G. (2015). Unexpected complications of low-risk pregnancies in the United States. American journal of obstetrics and gynecology, 212(6), 809.e1–809.e8096. doi: /j.ajog
(8) Grunebaum, A., McCullough, A. B., Arabin, B, Brant, R. L., Levene, M. I., & Chervenck, F. A. (2015). The safety of planned homebirths: a clinical fiction. BJOB Debate. Retrieved from
(9) Johantgen, M., Fountain, L., Zangaro, G., Newhouse, R., Stanik-Hutt, J., & White, K. (2012). Comparison of labor and delivery care provided by certified nurse-midwives and physicians: a systematic review, 1990 to 2008. Women’s Health Issues: Official Publication Of The Jacobs Institute Of Women’s Health, 22(1), e73–e81.
(13) Miller, A. C., & Shriver, T. E. (2012). Women’s childbirth preferences and practices in the United States. Social Science and Medicine, 75(4), 709–716.
(14) Phillippi, J. C., Danhausen, K., Alliman, J., Phillipppi, D. R. (2018). Neonatal outcomes in the birth center setting: A systematic review. Journal of Midwifery & Women’s Health. Retrieved from:
(15) Office of Disease Prevention and Health Promotion. (2010). Maternal, Infant, and Child Health. Retrieved from
* More references available upon request
n = 21
38% of wanted a CNM and only 29% employed one
71.4% would consider a CNM
19% wanted a freestanding birth center and 0% used one
42.9% would consider a freestanding birth center
No common social barriers but women wanted what they felt was safest