Leslie Pray, Rapporteur
Board on Children, Youth, and Families

                       INSTITUTE OF MEDICINE AND
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AN UPDA ON RESEARCH ISSUES TE IN THE ASSESSMENT OF BIRTH SETTINGS W O R K S H O P S U M M A RY Leslie Pray, Rapporteur Board on Children, Youth, and Families

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by Grant No. P3020147 between the National Acad- emy of Sciences and the W.K. Kellogg Foundation. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-28739-5 International Standard Book Number-10:  0-309-28739-1 Additional copies of this workshop summary are available for sale from the Na- tional Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; For more information about the Institute of Medicine, visit the IOM home page at: Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2013. An update on research issues in the assessment of birth settings: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

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PLANNING COMMITTEE ON RESEARCH ISSUES IN THE ASSESSMENT OF BIRTH SETTINGS: A WORKSHOP1 MAXINE HAYES (Chair), State Health Officer, State of Washington, Department of Health SHERIN U. DEVASKAR, Professor of Pediatrics and Executive Chair, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles ELLEN HODNETT, Professor, Lawrence S. Bloomberg Faculty in Nursing, University of Toronto HOLLY POWELL KENNEDY, Helen Varney Professor of Midwifery, School of Nursing, Yale University THOMAS C. RICKETTS, Professor of Health Policy and Administration and Social Medicine, Gillings School of Public Health, University of North Carolina at Chapel Hill JEANNETTE A. ROGOWSKI, University Professor in Health Economics, School of Public Health, University of Medicine and Dentistry of New Jersey DIANE L. ROWLEY, Professor of the Practice of Public Health, Gillings School of Public Health, University of North Carolina at Chapel Hill BENJAMIN P. SACHS, Senior Vice President and Dean, James R. Doty Distinguished Professor and Chair, School of Medicine, Tulane University IOM Staff SHEILA MOATS, Study Director JULIA HOGLUND, Research Associate (from May 2013) DOUGLAS KANOVSKY, Senior Program Assistant PATRICK BURKE, Financial Associate (until January 2013) FAYE HILLMAN, Financial Associate (from January 2013) PAMELA ATAYI, Administrative Assistant KIMBER BOGARD, Director, Board on Children, Youth, and Families 1  nstitute of Medicine planning committees are solely responsible for organizing the work- I shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the rapporteur and the institution. v

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Reviewers T his workshop summary has been reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent re- view is to provide candid and critical comments that will assist the institu- tion in making its published workshop summary as sound as possible and to ensure that the summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this summary: Kimberly Gregory, Cedars-Sinai Medical Center Amy J. Levi, University of New Mexico, Albuquerque Dale Reisner, Swedish Medical Center, Seattle Marla E. Salmon, University of Washington Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Hugh H. Tilson, University of North Carolina at Chapel Hill, School of Public Health. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this vii

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summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.

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Contents 1 Introduction 1 2 Context and Background 7 3 Assessment of Risk in Pregnancy 25 4 Birth Settings and Health Outcomes: State of the Science   47 5 Workforce Issues 77 6 Data Systems and Measurement 93 7 Costs, Values, and Reimbursement Issues Associated with Various Birth Settings 115 8 Perspective from Providers 133 9 Workshop Reflections: Moving the Research Agenda Forward 145 References 157 APPENDIXES A Workshop Agenda 167 B Moderator and Speaker Biographical Sketches 173 C Abbreviations and Acronyms 191 ix

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