Program

Nurse-Midwifery M.S.

Number of Pages

62

Year Approved

2026

First Advisor

Taneesha Douglas

Second Reader

Rebecca D'Addosio Smith

Abstract

Introduction: Home birth is a safe option for low-risk populations. As awareness of home birth increases, so do the families choosing home birth. Governing bodies recommend well integrated maternal health systems, yet the impact of level of integration on perinatal outcomes and patient satisfaction has not been specifically examined. The purpose of this integrative review is to identify the impact home birth integration has on maternal and neonatal outcomes, patient satisfaction, and how communities can improve their integration level.
Methods: A keyword search of current literature was conducted using CINAHL, PubMed, and Scopus databases. An additional hand search of 2 relevant journals was undertaken, yielding a total of 21 original studies that met all inclusion and exclusion criteria. Relevant outcomes, demographics and qualitative data were extracted and results were organized using the socio-ecological model.
Results: 21 studies representing integrated (n=321,310), unintegrated (n=7,253), and unknown/mixed integration systems (n=188,500) were included. Across settings, planned out-of-hospital (OOH) birth among low-risk individuals was associated with lower rates of cesarean and operative delivery, fewer interventions, decreased analgesia use, and higher rates of spontaneous vaginal birth and early initiation of breastfeeding. Neonatal outcomes were largely comparable across birth settings.
Findings were most consistent in integrated systems, where OOH birth demonstrated improved maternal outcomes and high patient satisfaction, including greater autonomy, respect, and continuity of care. In unintegrated systems, results were more variable; while most studies still showed improved maternal and neonatal outcomes, one study reported an association with adverse neonatal outcomes in the context of limited regulation and integration. Patient satisfaction in these settings reflected lower perceived respect and system support. Studies with unknown integration showed trends similar to integrated systems but with less contextual clarity.
Simulation-based transfer training (n=265) improved provider confidence, communication, teamwork, and readiness for obstetrical emergencies in both integrated and unintegrated systems.
Discussion: Literature shows that maternal and neonatal outcomes for planned home births are not significantly impacted by the healthcare systems integration level; however, integration still plays a key role in our maternal health system. Integration supports respectful care, improves patient satisfaction, collaboration between providers, and can strengthen the transfer process. Individuals, providers, facilities, and policy makers can do their part in improving integration through developing formal transfer protocols; conducting and participating in simulation training for the interdisciplinary team; cultivating collaborative relationships between hospital and community-based providers; and advocating for legislation that supports full-scope of practice for all trained midwives.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis

Terms of Use and License Information

Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

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