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A Woman's Place Birth and Health Resources
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attentive midwifery care
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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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American Journal of Public Health (1997)
A comparison of Family Practice physicians, OB physicians, and CNMs caring for low risk women showed a cesarean section rate of 15.1% for Family Practice physicians, 13.6% for OB physicians, and 8.8% for CNMs.
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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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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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New England Journal of Medicine (1989)
A Study of 11,814 women admitted in labor to (out of hospital) birth centers found a cesarean rate of 4.4%, half of that for low risk hospital births, and neonatal mortality of 1.3/1000 births (0.7/1000 when lethal anomalies were excluded), rates comparable to low risk hospital births.
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American Journal of Public Health (1992)
1707 intended home births by lay midwives during 1971-1989 were compared to 14,033 physician attended hospital births in 1980. The cesarean rate was 1.46% for the midwife group and 16.46% for the physician group, and perinatal death 1% vs 1.33%. Ten of the 17 perinatal deaths in the intended home birth group were due to congenital anomalies or prematurity. Of the home birth group, a total of 13.5% were transferred to the hospital before, during, or after labor. The writers conclude: "Support for home birth should not be withheld on the grounds that this option is inherently unsafe."
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