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Numerous studies have been done to study the safety and effectiveness of certified nurse-midwives, other midwives, home birth, and birth center birth. The evidence overwhelmingly shows that professional midwives provide safe care with excellent outcomes, and that birth can safely be accomplished outside of a hospital when proper precautions are taken.
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Journal of Epidemiology and Community Health (1998) This study of singleton vaginal deliveries at 35 to 43 weeks gestation compared outcomes of 153,194 deliveries by CNMs with 686,644 deliveries by MDs. Results showed that patients of CNMs had a 33% lower risk of neonatal mortality and a 31% lower risk of low birth weight. The CNM group included proportionately more minority, teen, and unmarried mothers. The authors conclude that "Differences between physician and CNMs in prenatal, labor, and delivery care practices may explain in part the differential outcomes."
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Canadian Medical Association Journal (2009) This matched cohort study compared the outcomes of planned home births attended by midwives to planned hospital births attended by midwives and physicians. The perinatal death rate was 0.35 per 1000 in the planned home birth group, 0.57 in the midwife attended planned hospital birth group, and 0.64 in the physician attended planned hospital birth group. Women in the planned home birth group were significantly less likely to experience obstetric interventions and adverse maternal outcomes than those in the midwife and physician attended planned hospital groups. Newborns in the home birth group were less likely than those in both hospital groups to require resuscitation at birth, oxygen therapy beyond 24 hours, and were less likely to have meconium aspiration. The authors state, "Our data indicate that screening for eligibility by registered midwives can safely support a policy of choice of birth setting."
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American Journal of Public Health (2003) This San Diego study of 2957 low risk, low income women compared results of those receiving collaborative midwife/OB care to those receiving physician-only care. Women receiving collaborative care had fewer cesarean, vacuum, and forcep deliveries, fewer epidurals, fewer episiotomies, and fewer inductions. (10.7 vs 19.1% cesarean, 8.4 vs 18.1% assisted vaginal birth, 29.8 vs 68.6% epidurals, 13.1 vs 37.8% episiotomy, 8.4 vs 14.7% inductions). The groups had similar rates of preterm birth and low birth weight.
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British Journal of Obstetrics & Gynecology (2009) In a study of over 280,000 women in the Netherlands, 68% of women completed childbirth under the exclusive care of a midwife. 3.6% were referred on an urgency basis and 28.3% were referred without urgency. The main reasons for urgent referrals were fetal distress and postpartum hemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively.On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group. The authors conclude that risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives.
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British Medical Journal (2005) 5,418 low-risk women who were planning to deliver at home with a Certified Professional Midwife were studied across |
Obstetrics and Gynecology (1998) A study of 1404 U.S. women intending to have a home birth found: 7.4% were referred during the pregnancy for a planned hospital birth, 8.3% were transferred during labor to the hospital, and 0.8% of mothers and 1.1% of infants were transferred to the hospital after delivery. Overall fetal and neonatal mortality for those beginning labor at home was 2.5/1000. Fetal and neonatal mortality for those actually delivering at home was 1.8/1000. The authors note that intrapartal mortality during intended homebirth is concentrated in postdates pregnancies with evidence of meconium passage.
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