Home Birth with Midwife as Safe as Hospital Birth

The above is a headline from the September 3, 2009 issue of USA Today. This article reports on a study published in the September 15, 2009 Canadian Medical Journal showing that planned home births with a registered midwife are slightly safer and have less complications than those attended by a physician in a hospital.

The study looked at all planned home births in British Columbia, Canada, from January 1, 2000, to December 31, 2004. The total number of births that met this criteria was 2889. These births were compared to 5331 similar births in hospitals. The main outcome recorded by this study was infant mortality. The additional outcomes recorded were the number of obstetric interventions and any other adverse mother and infant outcomes.

The results showed that the rate of infant death in the planned home birth was 0.35 per 1000 births. Conversely, the rate of death in planned hospitals births with a midwife was 0.57 per 1000. The highest death rate in the study was the hospital births attended by a physician which was 0.67 per 1000 births.

Planned births at home attended by midwives were also much less likely to have medical procedures or complications. The study noted that midwife attended births were less likely to have obstetric interventions, or adverse maternal outcomes, such as tearing or hemorrhage.

Infants born in planned home births attended by midwives were less likely to require resuscitation at birth or to require oxygen therapy beyond 24 hours. They were also less likely to require re-admittance to a hospital after birth than the group born and released from a hospital.

In the USA Today article, Dr. Marjorie Greenfield, associate professor of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland stated, “There is a political and economic issue about controlling where birth happens, but also a deep belief by physicians that it’s not safe to have your baby at home,” Greenfield said. “Doctors see every home-birth patient who had a complication, but we don’t see the ones that have these beautiful, fabulous babies at home who may breast-feed better or have less hospital-acquired infections. There may be medical benefits.”

The article noted that there is a difference in the registration process for midwives in Canada than in the United States. In the US laws vary by state with some areas having no regulatory process in place. Dr. Greenfield noted that the National Association of Certified Professional Midwives does have a certification process, but many states in the US don’t recognize it.

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