Birth Settings in America

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings. Table of Contents Front Matter Summary 1 Introduction 2 Maternal and Newborn Care in the United States 3 Epidemiology of Clinical Risks in Pregnancy and Childbirth 4 Systemic Influences on Outcomes in Pregnancy and Childbirth 5 Issues in Measuring Outcomes by Birth Settings: Data and Methods 6 Maternal and Newborn Outcomes by Birth Setting 7 Framework for Improving Birth Outcomes Across Birth Settings References Appendix: Biographical Sketches of Committee Members and Staff Board on Children, Youth, and Families