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COMPASSIONATE... Home Birth as Safe as Hospital Delivery for Low-Risk Pregnancies=2005 NEW YORK (Reuters Health) Jun 16 - Planned home births for low risk women using certified professional midwives are no more likely than hospital births to result in intrapartum and neonatal mortality, according to a report in the June 18th issue of the British Medical Journal. 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 prospective 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 women (12.1%) were transferred to a hospital. Excluding deaths of babies with fatal birth defects, the rate of intrapartum and neonatal mortality was 1.7 deaths per 1000 births, "similar to risks in other studies of low-risk home and hospital births in North America," the authors write. The rate of medical interventions was less than half of that observed in the comparison group. For instance, 2.1% of those in the home delivery group underwent episiotomy, compared with 33.0% of those in the control group. Similarly, rates of forceps delivery (1.0% versus 2.2%), vacuum extraction (0.6% versus 5.2%), and caesarean section (3.7% versus 19.0%) were lower in the home delivery group. The authors contacted approximately 10% of mothers to verify outcomes and to question them regarding their satisfaction with care. For all 11 questions, over 97% 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," Dr. Johnson and Dr. Daviss conclude. BMJ 2005;330:1416-1419. __________________________________________________________ Journal of Epidemiology and Community Health, Vol 52, 310-317 Midwifery care, social and medical risk factors, and birth outcomes in the USA MF MacDorman and GK Singh Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA. STUDY OBJECTIVE: To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors. DESIGN: Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors. STUDY SETTING: United States. PATIENTS: The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991. MAIN RESULTS: After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births. CONCLUSIONS: National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women. Copyright © 1998 by the Journal of Epidemiology and Community Health This article has been cited by other articles: (Search Google Scholar for Other Citing Articles) H. P. Kennedy The Midwife as an "Instrument" of Care Am J Public Health, November 1, 2002; 92(11): 1759 - 1760. _________________________________________________________ Policy Statements Adopted by the Governing Council of the American Public Health Association, October 24, 2001 Am J Public Health, March 1, 2002; 92(3): 451 - 483. _____________________________________________________ P. F Visintainer, J. Uman, K. Horgan, A. Ibald, U. Verma, and N. Tejani Reduced risk of low weight births among indigent women receiving care from nurse-midwives J. Epidemiol. Community Health, March 1, 2000; 54(3): 233 - 238.
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