Neonatal Outcomes in Planned Community Birth Settings

Background/Purpose: The safety of community births is a common point of discussion, especially in regard to neonates. Planned community births are supported for low risk, informed patients by the ACNM. The purpose of this literature review was to understand neonatal morbidity and mortality in planned community birth settings. Theoretical Framework: Orlando’s Nursing Theory focuses on immediate patient needs and promotes growth of nurses in unstable environments. This theory applies the competency of the nurse’s practice and the satisfaction of the patient. The Orlando Nursing Theory will be applied and explored as a framework in relation to neonatal outcomes in different birth settings. Results/Findings: It was identified that maternal characteristics, including parity, gestational length, and advanced maternal age, affect neonatal outcomes. Results showed that distance from the hospital did not affect neonatal outcomes in community births. The lowest rates of neonatal morbidity and mortality were found to be midwife-attended hospital births, compared to physician-attended births at the hospital and community births by midwives. Community births were found to be just as safe, or even had better neonatal outcomes, compared to hospital births. Limitations of the research existed due to small sample size and factors, such as maternal transfer during labor, that may have altered the results of some studies. Implications for Research and Practice: The data affect how midwives counsel patients about birth settings and safety, regardless of practice setting, and could spur recommendations for improving safety. Midwives, as the primary care attendants in home and birth center settings, have the priority to assess all outcomes that occur and provide efficient solutions if necessary. Further research is needed; in addition to identifying accurate representation of neonatal outcomes in the home and birth center setting, there is a need to alter and adjust research strategies. Controlling for the attendant present at delivery and modifying for the community's integration level of birth setting would provide results that are more transferable.