Staff schedules and doctor behavior could play a role in determining when births occur at US hospitals, new research suggests.
A study, published last month in the journal PLOS One, compared birthing trends in the US, England, and the Netherlands. The researchers found that vaginal births in US hospitals were most common between 8am and 5pm—the standard working hours for clinical staff—while US home births peaked in early morning hours from 2am to 5am.
By contrast, vaginal births in England and the Netherlands—countries that rely primarily on midwives, not obstetricians—occurred at similar times of the day as US home births, peaking between 1am and 6am, regardless of whether they took place at home or in a hospital, researchers noted.
Meanwhile, the average length of US pregnancies declined by more than half a week—39.1 weeks to 38.5 weeks—between 1990 and 2020, according to the study. In fact, nearly eight in 10 births in the US occurred before 40 weeks, compared to 56% in the Netherlands and 60% in England.
Researchers did not dive into the exact reasons for those differences, saying that it “merits future research.” Still, the authors raised an important question: “Would US maternity outcomes improve if care was organized to correspond to the natural rhythms of labor and the needs of laboring persons rather than organizational imperatives?”
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Maven Clinic’s Chief Medical Officer Neel Shah, who worked on the study, told Healthcare Brew that the daytime peak in US births likely reflects the widespread use of epidurals and “passive descent”—when physicians initiate pushing more than 30 minutes after a patient is fully dilated. The practice is less common in the Netherlands and England.
“If it’s 5am or 6am—anything in that window—and [a patient has] an epidural, they don’t have to push. If you’re like, ‘I’d rather just have them deliver during the morning shift,’ you could just wait,” said Shah, who also works as an ob-gyn at Beth Israel Deaconess Medical Center in Boston. “What this really indicates is the degree to which the American way of giving birth is centered around the clinicians and not the person giving birth.”
And with maternal health outcomes in America being “far, far, far worse” than in England or the Netherlands, Shah argued the study’s findings underscore the need to “reexamine what the maternal health model looks like in the US.”
“Every system is perfectly designed to get the results that it gets,” he said. “So if these are the results, it’s by design.”