Drs. Brocklehurst, Hollowell, de Jonge, Offerhaus, Klein, and others have provided valuable information so far on how different birth settings and models of obstetric care can be offered within an integrated healthcare system. Importantly, evidence from Canada and Europe suggests that risk of neonatal complications can be comparable between birth settings in such systems. The importance of systems integration, collaborative agreements, and transfer protocols have emerged as important themes in this discussion so far.
In this question, I ask our US, Canadian, and European colleagues: how might we translate these systems approaches to a US context? Given our fragmented healthcare systems, it seems likely that we will need to strategically adjust some of the approaches that have proven effective in other countries, in order for them to be effective in the US.