Homebirth Study Outcomes

Woohoo!! The largest homebirth study with certified professional midwives has finally been published in the British Medical Journal (full text version, also available in abstract and abridged versions):

Kenneth C Johnson and Betty-Anne Davis. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ, Jun 2005; 330: 1416.

I am so excited to see this paper in print and the solid evidence provided:

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.

Now before any Canadian's get their tail in a knot, the women in this study were from both Canada and the US, though the control group were all US based. The paper's discussion concludes with:

An economic analysis found that an uncomplicated vaginal birth in hospital in the United States cost on average three times as much as a similar birth at home with a midwife in an environment where management of birth has become an economic, medical, and industrial enterprise. Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions. Our results are consistent with the weight of previous research on safety of home birth with midwives internationally. This evidence supports 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. We recommend that these findings be taken into account when insurers and governing bodies make decisions about home birth and hospital privileges with respect to certified professional midwives.