Provider Perspectives on Community Birth Transfers: Analysis of Personal Values and Attitudes Toward Community Birth Among Maternity Care Providers in Community and Hospital Settings.

Abstract

Introduction: Out-of-hospital community births account for 1.6% to 2% of births in the United States and are associated with fewer obstetric interventions but increased neonatal risk. Little is known about how maternity care providers' characteristics, values, and prior exposure to community birth influence attitudes toward community birth.

Methods: We conducted an observational cross-sectional survey using a 40 to 43 item Research Electronic Data Capture questionnaire distributed October 2 to 30, 2024. Eligible participants ("providers") included in-hospital physicians, midwives, community birth providers, and registered nurses. The survey assessed demographics, practice characteristics, provider values, prior community birth experience, and attitudes toward community birth. Descriptive statistics were used to summarize characteristics. Group comparisons between in-hospital and community birth providers were conducted using analysis of variance and χ² or Fisher exact tests. Associations between attitudes and provider values were evaluated using linear models with Bonferroni correction.

Results: Sixty-seven providers completed the survey (51 in hospital, 16 community based). Most respondents were female (89.6%) and White (77.6%), with a median of 7 years in practice (IQR, 3-14.5). Attitudes significantly differed by role (P =  .007) and credentials (P =  .002). In-hospital providers reported safety concerns about community birth and perceived antenatal counseling to be inadequate. Perceived patient distrust during transfer was common among both in-hospital and community-based providers (69% and 81%, respectively). After adjustment for provider role and multiple comparisons, no significant differences in personal values were noted by attitude group; however, providers with positive attitudes toward community birth were more likely to believe that patients value compassion (β = 2.3, P =  .004).

Discussion: Provider attitudes toward community birth appear to be shaped more by professional role and clinical experience than by differences in underlying value systems. High levels of perceived patient distrust during transfer highlight the need for interventions that strengthen compassion across maternity care settings.