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

doi:10.1136/bmj.330.7505.1416

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

Kenneth C Johnson, senior epidemiologist¹, Betty-Anne Daviss, project manager²

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

Correspondence to: K C Johnson ken_lcdc_johnson{at}phac-aspc.gc.ca

Objective To evaluate the safety of home births in North Americainvolving direct entry midwives, in jurisdictions where thepractice is not well integrated into the healthcare system.

Design Prospective cohort study.

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

Participants All 5418 women expecting to deliver in 2000 supportedby midwives with a common certification and who planned to deliverat home when labour began.

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

Results 655 (12.1%) women who intended to deliver at home whenlabour began were transferred to hospital. Medical interventionrates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%),vacuum extraction (0.6%), and caesarean section (3.7%); theserates were substantially lower than for low risk US women havinghospital births. The intrapartum and neonatal mortality amongwomen considered at low risk at start of labour, excluding deathsconcerning life threatening congenital anomalies, was 1.7 deathsper 1000 planned home births, similar to risks in other studiesof low risk home and hospital births in North America. No mothersdied. No discrepancies were found for perinatal outcomes independentlyvalidated.

Conclusions Planned home birth for low risk women in North Americausing certified professional midwives was associated with lowerrates of medical intervention but similar intrapartum and neonatalmortality to that of low risk hospital births in the UnitedStates.

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