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Perceived safety and support for low-risk pregnancies in the birth center context

Sanders, Sarah (2018) Perceived safety and support for low-risk pregnancies in the birth center context. Master's Thesis, University of Pittsburgh. (Unpublished)

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Fewer than 1% of births in the United States occur in birth centers, which produce excellent outcomes for the thousands of women cared for in this setting. Birth centers are independent health care facilities, typically managed by midwives, and often with collaborating physicians. A national study demonstrated a 6% rate of cesarean section, and a 1.1% rate of preterm birth. Much of the literature surrounding how a pregnant woman chooses her birth site highlights the client’s perception of safety and control. In the United States, the medical model has dominated in prenatal care, focusing on screening and intervention in an effort to avert poor birth outcomes. Consequently, physician-managed care during pregnancy has become the default. However, given that an estimated 85% of pregnancies are considered low-risk, a specialized environment like the hospital is not always necessary. In fact, some studies show that hospitals are statistically less safe for this low-risk population, given the increased chance for unnecessary medical interventions. The present study was a secondary analysis of data provided by a single birth center, containing information about the timing and reasoning for clients’ birth site selection. These data were used to meet the two specific aims of the study: 1) identify variables associated with low-risk birth center clients planning for elective hospitalization; and 2) describe this low-risk case group by their rationale for choosing to deliver in hospital. Chart review and questionnaire data were collected for the case group in order to evaluate those clients’ decision-making processes. Results revealed that sampled clients were primarily concerned about the stress of a potential transfer to a hospital during labor. Perceived social support was also a major theme, not only regarding clients’ birth plan but also for their maternal responsibilities in the postpartum period. Clients expressed anxiety over potential complications in labor and birth, as well as challenges in adequate communication between client and provider. The public health significance of these findings lies in the furthered understanding of the factors that influence birth site, particularly in the low-risk
pregnant population.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Sanders, Sarahsarahannalise@gmail.comsas436
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorTerry,
Committee ChairTerry,
Committee MemberBurke,
Committee MemberNiemczyk,
Date: 28 June 2018
Date Type: Publication
Defense Date: 11 April 2018
Approval Date: 28 June 2018
Submission Date: 12 April 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 66
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: birth center, midwifery model, decision-making, maternal autonomy, pregnancy, birth
Date Deposited: 28 Jun 2018 19:47
Last Modified: 28 Jun 2018 19:47


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