Home Birth Summit

The Birth Place Lab (Coordinates FAM-funded projects)

The Birth Place Lab, in the Faculty of Medicine at UBC, enables multi-disciplinary and community-based participatory research on access to high quality maternity health care, and physiologic labor and birth, across birth settings. Many of the research projects were generated by the Home Birth Summits (2011, 2013, 2014) that convened 150 national leaders to develop a Common Ground Agenda around improved integration of maternity care services across birth settings in the United States. Summit delegates represented diverse stakeholder perspectives and include consumers, physicians, midwives, nurses, researchers, ethicists, educators, policy makers, legislators, health systems, payor and liability experts. The Summit outcomes were considered so significant and timely that they were read into the United States Congressional Record by Representative Lucille Roybal-Allard (November 2011).

Professor Vedam, Chair of the Birth Place Lab and her staff facilitate the multiple strategic initiatives, developed by each of 9 delegate-led Task Forces. The shared goals are:

  • to examine and improve access to safe, respectful, and affordable maternity care;
  • to enhance inter-professional collaboration; and
  • to enable patient-responsive and population-specific research on maternity experience and outcomes.

The Birth Place Lab has collaborated on several projects that prioritize the advancement of evidence-based policy related to birth place and equity in maternity care. Along with the Best Practice Guidelines: Transfer from Planned Home Birth to Hospital, the Collaboration Task Force has been promoting the Maternal and Newborn Transfer Forms and Receiving Nurse Script, a package of implementation tools for midwives and receiving hospital staff. Current research projects include: Giving Voice to Mothers, a participatory research project aimed at assessing how planned place of birth, race and ethnicity interact with the experience of maternity care in the US and the Access and Integration Maternity Mapping (AIMM) study that links maternal and fetal outcomes to birth setting and integration of skilled providers in each of the 50 states.

Giving Voice to Mothers Study (partially funded by FAM in 2015 & 2016)

Disparities in adverse perinatal outcomes between Caucasian people and persons of colors are well-documented. Our Giving Voice to Mothers study exposes how, race, and ethnicity, and planned place of birth interact with experiences of maternity care, including discrimination and disrespect, as well as access to midwives and physiologic birth. Following extensive community consultations we created a survey to help pregnant persons to tell their stories. We partnered with multiple NGOS who serve communities of colors and those who planned home births in the US. Over 2800 women have responded to date.

No previous study has allowed marginalized women in the US to:

  1. Design quality measures on the most relevant factors that affect their own lived experience.
  2. Lead the interpretation of the results of applying those measures in their own communities.
  3. Decide how tell their story to consumers, policy makers, and health care leaders.

The survey was designed and content validated through an extensive consultation with community members including Non-Hispanic Black, Hispanic, and Native maternity clients. To collect authentic person-centered data on maternity care experiences across race, regions and settings, the survey instrument includes validated quality and safety measures s including the Mothers Autonomy in Decision Making (MADM) scale, the Mothers on Respect index (MORi); and the Perceptions of Racism scale. These tools ca be used as quality care measures in the United States.

No previous large quantitative US studies have allowed marginalized populations to engage in a process to choose, design, and content validate the items of importance to them. The patient-generated information about access to maternity care options, experiences of decision-making in maternity care, including being heard and treated with respect, and the impact of institutional racism in communities of color gathered by Giving Voice to Mothers, will lead to data driven strategies to improve maternity care for ALL types of women.

The goals of this study are:

  1. To learn about which maternity care options are most important to all types of pregnant families.
  2. To understand experiences of maternity care in communities of color.
  3. To find out how families decide where to give birth and if place of birth affects their experiences.
  4. To describe the experience of making decisions during pregnancy and birth, including being heard and treated with respect.
  5. To learn about any differences among doctors, midwives, or consumers that may affect maternity care choices.

Next steps will be to “tell the story” and develop a pragmatic implementation plan for institutions, clinicians, and policy makers to respond to findings. Our network of childbearing families (educators, web designers, videographers, writers, journalists, bureaucrats, social workers, settlement counselors, community organizers) have a diversity of professional talent and energy to dedicate to the continuing work on this important topic.

Access and Integration of Maternity care Maps (partially funded by FAM in 2015 & 2016)

In 2013-14 multiple organizations, including FAM, funded the development of the HBS Regulation and Licensure Database, a state-by-state record of the regulatory conditions for midwifery practice (and by extension, women’s access to physiologic birth and choice of birth place). This work led to the Access and Integration of Maternity Care Mapping (AIMM) Study.

The AIMM Study was conceived and prioritized by a panel of over 20 maternity care providers and experts on home birth research at Summit III. We populated a comprehensive database that includes information about the regulation and scope of CNMs, CPMs, and CMs in each state, as well as level of integration of midwives into the regional health care systems and access to high quality maternity care.

IN 2016, our multi-disciplinary team developed a scoring system that ranks states on the level of integration of midwives, and access to high quality care at home, birth centers and hospitals. By examining state scores to rates of physiologic birth, interventions, and maternal-newborn well-being we have produced several interactive maps displaying the AIMM state-by-state “report card”. This study presents an unprecedented opportunity to help policy makers understand the links between improved maternal-newborn health, and equitable access to midwife-led care in all birth settings.