The following is written and published by Citizens for Midwifery © 2005 Permission to reprint with attribution New landmark North American study shows that Planned Home Births Are Safe The largest study of home births attended by Certified Professional Midwives, as published in the British Medical Journal, has found that home birth is safe for low risk women and involves far fewer interventions than similar births in hospitals. Safe & Healthy Outcomes Results are consistent with most studies of planned home births and low risk hospital births Zero maternal deaths Intrapartum and neonatal mortality: 2.0 per 1000 intended home births (only 1.7 per 1000 intended home births when planned breech and twin births are excluded) Immediate neonatal concerns resulted in just 2.4% being placed in neonatal intensive care. At six weeks well over 90% of mothers were still breastfeeding their babies
Low Rates of Medical Intervention | Planned home birth | Hospital birth | Induction of labor (only with oxytocin or prostaglandins) | 2.1 % * | 21.0% | Stimulation of labor (only with oxytocin) | 2.7% * | 18.9% | Electronic fetal monitoring | 9.6% | 84.3% | Episiotomy | 2.1 % | 33.0% | Vacuum Extraction | 0.6% | 5.5% | Cesarean Section | 3.7% | 19.0% |
* These numbers differ from the BMJ article where data for CPMs included forms of induction and stimulation only used by midwives and not comparable to hospital births. Satisfied Mothers Few Transfers to Hospital Care Only 12.1% transferred to hospital intrapartum or postpartum Five out of six transfers were before delivery, most for failure to progress, pain relief or exhaustion Midwife considered transfer urgent in only 3.4% of intended home births
High Credibility Included all home births involving Certified Professional Midwives in the year 2000 5,418 women in the U.S. and Canada who intended to give birth at home as of the start of labor Prospective - every planned home birth was registered in the study prior to labor and delivery
'Outcomes of planned home births with certified professional midwives: large prospective study in North America.' ~ Kenneth C Johnson and Betty-Anne Daviss. BMJ 2005; 330:1416 (18 June). This article and related letters to the editor are available online, free, at: Outcomes of Planned Home Births With Certified Professional Midwives For a PDF version of Outcomes of Planned Home Births With Certified Professional Midwives PDF for a PDF version of the study More........ Further Information from co-author Betty-Anne Daviss: The British Medical Journal has embargoed a press release until tomorrow (up on their website at bmj.org) regarding the largest study ever done of its kind on home birth. What the press release does not point out is that it was conducted by two Canadian researchers who live in Ottawa -- a Canadian epidemiologist and a Canadian midwife. It was carried out on all clients having a delivery with a certified professional midwife for a given time period and reports on 5,418 births. The majority of the births were done by American midwives but Canadian midwives were also included in the study. The study shows that -- if you aren't a high risk Mom carrying twins, having a premature baby or baby coming bottom first, all of which can be judged ahead of time -- your chance of having a healthy normal safe delivery are the same whether you plan a home or hospital birth. However, if you choose the home birth your intervention rates will be a tenth to a half of what they would be in hospital, compared to figures of the same time period from the National Health Institute of the US The study is groundbreaking because former studies have been criticized for not being big enough, for not being able to distinguish between planned or unplanned births, and for being retrospective, that is only looking at old records as opposed to engaging health professionals in the requirement of registering births they were going to do and then having to account for all outcomes. As well, over 500 mothers were phoned to verify whether what the midwives said at the births actually happened. The study suggests that legislators and policy makers should pay attention to the fact that this study supports the American Public Health Association resolution to increase out of hospital births done by direct entry midwives. The American College of Obstetricians and Gynecologists still opposes home birth. The SOGC has written a statement acknowledging that women have the right to choose their place of birth. Betty-Anne Daviss, Registered Midwife
co-principal investigator of the study Betty-Anne Daviss, Project Manager, FIGO Safe Motherhood/Newborn Initiative, Housed at The Society of Gynaecologists and Obstetricians of Canada, 780 Echo Drive, Ottowa, Canadatel: +1 800 561 2416 OR +1 613 730 4192 Ext. 263 Email: badaviss@sogc.com And more..... Press Release from BMJ Planned home births in the United States are safe, say researchers Outcomes of planned home births with certified professional midwives: large prospective study in North America BMJ Volume 330, Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week's BMJ. Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited. In the largest study of its kind internationally to date, researchers analyzed over 5000 home births involving certified professional midwives across the United States and Canada in 2000. Outcomes and medical interventions were compared with those of low risk hospital births. Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America. A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital. 'Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions," say the authors. "This evidence supports the American Public Health Association's recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States.' Contact: Kenneth Johnson, Senior Epidemiologist, Surveillance and Risk Assessment Division, Center for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Canada Tel: +1 613 957 0339 To arrange an interview, please call Aggie Adamczyk: +1 613 941 8189 (Public Health Agency media contact) Email: ken_lcdc_johnson@phac-aspc.gc.ca back-to-top
American Public Health Association's recommendations 'Recognizing the evidence that births to healthy mothers, who are not considered at medical risk after comprehensive screening by trained professionals, can occur safely in various settings, including out-of-hospital birth centers and homes. ...Therefore, APHA supports efforts to increase access to out-of hospital maternity care services…'
American Public Health Association, increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002.
back-to-top Claudine Crews LM, CPM Licensed and Certified Professional Midwife Home Birth Specialist For a free consultation contact me at: Midwifery Services of South Texas 830-393-0337 or 210-710-3169 midwifeservices@gmail.com | 
