a. Gestational age distributions in 2020, all births, England, the Netherlands and the US. Source: USA: CDC Wonder. England: Office for National Statistics. The Netherlands: Peristat.nl. b. Gestational age distribution* Home births, England, 2008–2010 & Netherlands & USA 2020. * For comparison with data from England, data limited to births at 37+ weeks; “0%” refers to less than 0.5%. Sources: USA: CDC Wonder. England: Birthplace Study. The Netherlands: Peristat.nl. Credit: PLOS ONE (2023). DOI: 10.1371/journal.pone.0278856
Maternal health outcomes continue to deteriorate in the United States, where maternal and child mortality rates are much higher than in European countries and other wealthy countries. Now, a new study led by researchers from the Boston University School of Public Health (BUSPH) and Harvard Medical School-affiliated Beth Israel Deaconess Medical Center (BIDMC) provides insight into how hospital organizational structures and staffing levels within the U.S. maternity care sector may influence childbirth. . process and potentially contribute to adverse birth outcomes.
Published in the magazine PLOS ONEthe study analyzed gestational age patterns and timing of home and hospital deliveries in three high-income countries: the US, which embrace a maternity care model that relies heavily on midwives and clinical interventions, and England and the Netherlands, which rely primarily on midwives who provide low-cost maternity care. grant.
The findings show that the average length of pregnancies in the US steadily decreased by more than half a week from 39.1 weeks to 38.5 weeks between 1990 and 2020, and that pregnancies in the US are on average shorter than pregnancies in England and the Netherlands. In 2020, only 23 percent of births in the US occurred at 40 weeks or more, compared to 44 percent of births in the Netherlands and 40 percent of births in England. The pattern of gestational age in home births was similar in all three countries.
In all three countries, the researchers also examined birth timing by hour of the day for home births and vaginal hospital deliveries, and repeated this analysis, limiting the comparison to hospital vaginal deliveries without interventions such as induction or labor augmentation that would may change the timing.
In England and the Netherlands, home and hospital deliveries occurred at similar times of the day, peaking in the early morning hours between 1 a.m. and 6 a.m.
But in the US, there was a noticeable difference in birth timing between the two settings: Home births peaked in the same early morning hours as home deliveries in other countries. In contrast, hospital deliveries – even those without interventions that might influence the natural timing pattern – largely occurred during standard working hours for clinical staff, from 8 a.m. to 5 p.m.
The paper is the first international study to use large datasets to compare gestational age and birth time in three high-income countries; most previous research has focused on data from individual hospitals or countries. Given the superior birth outcomes of England and the Netherlands, the authors say their findings suggest that US maternity care models could benefit from an organizational shift that de-emphasizes active, clinical management of labor and allows the birth process to flow naturally.
“Our cross-country analysis shows that the US is an outlier in the distribution of gestational age and timing of hospital deliveries with little intervention,” said lead researcher and corresponding author Dr. Eugene Declercq, professor of community health sciences at BUSPH. “There is a lesson to be learned from countries with more positive pregnancy outcomes than the U.S. in making hospital workforce planning and operational plans more closely aligned with the natural patterns of birth timing and gestational age rather than trying to adapt birth timing to the needs of the organization .”
The study included nationally representative and publicly available population-based birth data from all three countries, including data on more than 3.8 million births in the US and 156,000 births in the Netherlands in 2014, and more than 56,000 births in England from 2008-2010. The researchers examined home and hospital birth timing for births between 37 and 42 weeks.
“Each system is perfectly designed to get the results it gets,” said senior author Dr. Neel Shah, chief medical officer of Maven Clinic and a visiting scientist at BIDMC. “The alarmingly poor outcomes of the U.S. maternal health system require more attention to its design. Our study shows that U.S. hospitals, compared to other high-income countries, may be more focused on the convenience of clinicians than on the needs of people giving birth.”
Eugene Declercq et al, The natural pattern of birth timing and gestational age in the US compared to England and the Netherlands, PLOS ONE (2023). DOI: 10.1371/journal.pone.0278856
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