For expectant women at low risk for complications, planned home births for using certified professional midwives are just as safe as hospital births, according to a new report. Moreover, the good outcomes are achieved using fewer medical interventions.
Dr. Kenneth C. Johnson, with the Center for Chronic Disease Prevention and Control, and Dr. Betty-Anne Daviss, with the International Federation of Gynecology and Obstetrics, both in Ottawa, Canada, conducted what they believe to be the largest study of planned home births to date.
Included were 5418 women in Canada and the US who planned to deliver at home in the year 2000 using certified midwives.
The authors compared outcomes for these women with more than 3 million in-hospital births in the US in 2000.
A total of 655 home-birth women (12 percent) were transferred to a hospital.
Excluding deaths of babies with fatal birth defects, the rate of neonatal mortality was 1.7 deaths per 1000 births. This rate is “similar to risks in other studies of low-risk home and hospital births in North America,” the authors write in the British Medical Journal.
The rate of medical interventions among the home births was less than half of that in the comparison group.
For instance, 2.1 percent of those in the home delivery group underwent episiotomy, compared with 33.0 percent of those in the hospital group. Similarly, rates of forceps delivery (1.0 percent versus 2.2 percent) and caesarean section (3.7 percent versus 19.0 percent) were lower in the home delivery group.
The team contacted approximately 10 percent of mothers to verify outcomes and to question them regarding their satisfaction with care. For all 11 questions, over 97 percent reported that they were “extremely or very satisfied.”
These findings “support 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,” Johnson and Daviss conclude.
SOURCE: British Medical Journal, June 18, 2005.
Revision date: July 9, 2011
Last revised: by Janet A. Staessen, MD, PhD