|ICEA Virginia Larsen Research Grant
The Alabama Birth Study
A Statistical Analysis of Home Birth Midwives and Childbirth Education 1980-2000
Team Leader: Nancy Mitchell-Merrill, BSN RN, ICCE,
Team Members: Lisa Clark, Steve Merrill, Kelley Swatzell
Upon working with some legislative issues regarding midwifery, I learned the state of Alabama prints a home birth packet and does not compile the information into any useful format in the protection of those who participate in or choose homebirth options.
The question arises, "What are the outcomes throughout the state for homebirth mothers and babies and what is the source of these outcomes?" Is it the educational level of the mothers, the instruction given by the midwives, or other independent educators?
Thus we ask the question to be studied, "How has information and education impacted the childbirth choices of women in Alabama choosing homebirth? Does information provided by homebirth midwives and childbirth educators in Alabama result in better birth outcomes for the mother, for the newborn?" We attempted to answer this question by surveying Alabama midwives, childbirth educators, and Alabama birth certificate data.
The question asked of this study is "How has information and education impacted the childbirth choices of women in Alabama choosing homebirth? Does information provided by homebirth midwives and childbirth educators in Alabama result in better birth outcomes for the mother, for the newborn?" The answer to this appears to be "yes;" yet it is difficult to quantify any statistical measurement due to the lack of sufficient data and participation of the population sampled. While there have been many years of homebirth mothers completing homebirth packets provided by the state of Alabama, this information has never been tabulated for any statistical purposes and was not made available for us to use. This researcher believes that the hours spent per midwife and educator providing resources for their clients helps promote better outcomes for the mothers and their babies. Although one cannot disallow that there are other factors involved in this equation, education is certainly a factor.
See the details in the International Journal of Childbirth Education, September 2006, Volume 21, Number 3, reference #IC2603.
has information and education impacted the childbirth choices
of women in Alabama choosing home birth?
Methods to be used to answer research questions, including
population to be studied, data collection methods, and
statistical techniques to be used. (data)
population to be studied will be child bearing women in
the state of Alabama who chose home birth between the years
1980 to 2000 including their midwives and childbirth educators.
I intend to survey midwives
in Alabama concerning the amount and type of childbirth education
and information they provide to clients. This will be followed
up with a study of Alabama birth certificate data for the
years 1980 to 2000 to obtain information concerning birth
outcomes during this period of time.
The statistical techniques
I intend to use will include descriptive and inferential
methods using population, sample, and parameters to determine
relational standard deviations.
Anticipated time frame to complete research. (dates
birth certificate data from the Center for Vital Statistics
by 4 July 2003.
and conduct survey of midwives and educators by 4 August
results of midwives' survey by 4 September 2003
data and compile report by 13 October 2003.
How results will be used. (data)
State of Alabama 5 year Maternal and Child Health Needs Assessment
2001 identifies 10 priority maternal child heath needs
that the areas of concern in the current health care system.
The results of this study will potentially address four
of the ten priority needs:
health education and outreach
African American infant mortality
very low birth weight in African Americans
access to prenatal care
state of Alabama presently limits childbirth choices to
hospital birth or unattended home birth, by making the
practice of home birth midwifery illegal. The applicant
intends to use the results of this study to affect changes
in legislation and public health policy by demonstrating
the benefits to mothers and babies of education and information
provided by an independent health care provider.
How the proposed research is relevant to ICEA's mission
and goals. (data)
Mitford, in The American Way of Birth, declared Montgomery,
Alabama the most dangerous place in America to give birth.
That was in 1990 , and since then there has been little
improvement. Alabama has higher infant mortality rates,
higher C-section rates, lower VBAC rates, and higher rates
of low birth weight babies as compared to the rest of the
nation. The applicant believes this is due, in large part,
to a lack of independent childbirth education and information.
The results of this study will be used to demonstrate the
positive effects of "freedom of choice based on knowledge
of alternatives in family-centered maternity and newborn
care," with a focus on the midwife as a choice that is
not currently, but should be, legally available in Alabama
as an alternative maternity care provider.
Other funding sources participating in this research.
at present. All team members are volunteers. Money from
this grant will be applied to actual costs for expenses.
13 January, 2007