Outcomes of planned home births with certified professional midwives: large prospective study in North America
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager
Home Birth in High Resource Countries
USA
Home birth has had a difficult legacy in the United States of America. Following a rise in the home birth rate due to hippie, religious, and feminist groups fighting back in the 1970s against increasing interventions in hospital, the American College of Obstetricians and Gynaecologists (ACOG), began to put out statements opposing home birth. For 30 years this opposition was not based on actual research, but merely on obstetric opinion. It was not until our study, Outcomes of planned home births with certified professional midwives: large prospective study in North America was published in another country—the UK, at the British Medical Journal (BMJ)—and Ricki Lake’s film, The Business of Being Born, which quoted the study, that ACOG began to mention research in their home birth statements. That was in 2006.
The story of the safety, politics, and economics of home birth, which includes a history of ACOG home birth statements, is told in Chapter 7 of Birthing Models on the Human Rights' Frontier. The American obstetricians' search for accurate information finally, deep into the milenium, brought them to agree that studies have demonstrated the safety of home birth in countries where birth in the community, in women's homes or freestanding birth centres, is an integral part of the system. Their organization does not believe the weight of evidence applies to their country because it is not well integrated. It is not well integrated largely because the major obstetric society continues to make it difficult for home birth midwives to practice and have hospital privileges for easy access to transport
Canada, Australia, and Europe
The Society of Obstetricians and Gynaecologists of Canada (SOGC) officially changed their opposition to home birth after midwifery became a legal profession in Ontario and Quebec 1993-1994 and began to sweep across the country.
Home birth in New Zealand and Australia has had a rocky existence as it has in much of Europe, the Netherlands being the notable exception, which, along with the UK have published outstanding home birth studies that are cited below.
Abstract
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To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.
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Prospective cohort study.
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All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.
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All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.
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Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.
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655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.
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Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.