BMJ  2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Paper

Outcomes of planned home births with certified professional midwives: large prospective study in North America

¹ Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, ² Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada

Objective 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.

Design Prospective cohort study.

Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants 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.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

Results 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.

Conclusions 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.

This article has been cited by other articles:

• Cheyney, M. J. (2008). Homebirth as Systems-Challenging Praxis: Knowledge, Power, and Intimacy in the Birthplace. Qual Health Res 18: 254-267 [Abstract]  
• Drife, J. (2007). Putting risk into context. The Obstetrician and Gynaecologist 9: 42-47 [Abstract] [Full text]  
• (2006). Planned Home Birth: Safe for Selected Women. JWatch Women's Health 2006: 6-6 [Full text]  
• (2005). Certified-Midwife-Attended Home Births Are Safe. JWatch Women's Health 2005: 3-3 [Full text]  

Rapid Responses:

Read all Rapid Responses

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bmj.com, 17 Jun 2005 [Full text]

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