MacDorman Marian F, Barnard-Mayers Ruby, Declercq Eugene
Maryland Population Research Center, University of Maryland, College Park, Maryland, USA.
Boston University School of Public Health, Boston, Massachusetts, USA.
Birth. 2022 Sep;49(3):559-568. doi: 10.1111/birt.12627. Epub 2022 Feb 25.
Anecdotal and emerging evidence suggested that the 2020 COVID-19 pandemic may have influenced women's attitudes toward community birth. Our purpose was to examine trends in community births from 2019 to 2020, and the risk profile of these births.
Recently released 2020 birth certificate data were compared with prior years' data to analyze trends in community births by socio-demographic and medical characteristics.
In 2020, there were 71 870 community births in the United States, including 45 646 home births and 21 884 birth center births. Community births increased by 19.5% from 2019 to 2020. Planned home births increased by 23.3%, while birth center births increased by 13.2%. Increases occurred in every US state, and for all racial and ethnic groups, particularly non-Hispanic Black mothers (29.7%), although not all increases were statistically significant. In 2020, 1 of every 50 births in the United States was a community birth (2.0%). Women with planned home and birth center births were less likely than women with hospital births to have several characteristics associated with poor pregnancy outcomes, including teen births, smoking during pregnancy, obesity, and preterm, low birthweight, and multiple births. More than two-thirds of planned home births were self-paid, compared with one-third of birth center and just 3% of hospital births.
It is to the great credit of United States midwives working in home and birth center settings that they were able to substantially expand their services during a worldwide pandemic without compromising standards in triaging women to optimal settings for safe birth.
轶事和新出现的证据表明，2020年的新冠疫情可能影响了女性对社区分娩的态度。我们的目的是研究2019年至2020年社区分娩的趋势以及这些分娩的风险概况。
将最近公布的2020年出生证明数据与前几年的数据进行比较，以分析按社会人口统计学和医学特征划分的社区分娩趋势。
2020年，美国有71870例社区分娩，其中包括45646例家庭分娩和21884例分娩中心分娩。从2019年到2020年，社区分娩增加了19.5%。计划内家庭分娩增加了23.3%，而分娩中心分娩增加了13.2%。美国每个州以及所有种族和族裔群体的分娩数量都有所增加，尤其是非西班牙裔黑人母亲（增加了29.7%），不过并非所有增加都具有统计学意义。2020年，美国每50例分娩中有1例是社区分娩（2.0%）。与在医院分娩的女性相比，计划在家中和分娩中心分娩的女性出现几种与不良妊娠结局相关特征的可能性较小，这些特征包括青少年分娩、孕期吸烟、肥胖以及早产、低体重和多胞胎。超过三分之二的计划内家庭分娩是自费，相比之下，分娩中心分娩的这一比例为三分之一，而医院分娩的仅为3%。
在美国，在家中和分娩中心工作的助产士在全球大流行期间能够大幅扩大服务，同时在将女性分诊到安全分娩的最佳场所时不降低标准，这值得高度赞扬。
