Intended for healthcare professionals


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

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:1416
  1. Kenneth C Johnson, senior epidemiologist (ken_lcdc_johnson{at},
  2. Betty-Anne Daviss, project manager2
  1. 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. 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada
  1. Correspondence to: K C Johnson
  • Accepted 20 April 2005


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.


  • Contributors KCJ and B-AD designed the study, collected and analysed the data, and prepared the manuscript. KCJ is guarantor for the paper.

  • Funding The Benjamin Spencer Fund provided core funding for this project. The Foundation for the Advancement of Midwifery provided additional funding. Their roles were purely to offset the costs of doing the research. This work was not done under the auspices of the Public Health Agency of Canada or the International Federation of Gynecology and Obstetrics and the views expressed do not necessarily represent those of these agencies.

  • Competing interests None declared.

  • Ethical approval Ethical approval was obtained from an ethics committee created for the North American Registry of Midwives to review epidemiological research involving certified professional midwives.

  • Accepted 20 April 2005
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