http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

 

Abstract
Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.

Design Prospective cohort study.

Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

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.


The following message is from the Grassroots Network News

Message 506012

CPM 2000 Study Published!  (long message)

Dear Friends,

The long-awaited study of home births attended by CPMs during the year 2000 is finally here! 

“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ  2005;330:1416 (18 June).

The BMJ has published the paper on-line. Read it at http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

Published in the June 18 issue of the North America British Medical Journal, the study found that “planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births” according to the BMJ press release (see below).

Co-author Ken Johnson has stated that this is the largest study of its kind at this time.  The study is prospective (initial data submitted before the birth took place, so no births could be “left out”) and includes data from more than 5000 births in the U.S and Canada.  This study cannot be written off for being too small or not relevant to US populations and circumstances.

The BMJ also has a “rapid response” feature, where readers can post letters about articles (comments, responses, etc.). As the BMJ states:  “Think of Rapid Responses as electronic letters to the editor.”  On the BMJ home page www.bmj.com find “Interactions” in the menu list on the left, and choose “Rapid Responses” for more information. CfM is posting a rapid response shortly.

Would you like to see your local newspaper report about this study? The BMJ will have posted their press release to wire services, but this study may not be considered hot news by very many newspapers.  However, midwifery advocates all over the country can help get news attention on this study, especially if your state is working on midwifery legislation.  You may even be able to use this study as a way to bring a fledgling group and its work to positive public attention.  The best situation is when someone already has a relationship with a news reporter at your local newspaper (you have talked with them before, you have given them any news tips, etc.). Call up your contact and talk with them about this study and its relevance in your community, offer them the BMJ press release (see below) and additional information from author Betty-Anne Daviss (see below).  If you have a local birth network or birth-related advocacy group of any kind, make sure to let the reporter know how the study is relevant to your group and what it is doing. If you don’t already have a contact at your local paper, you could use this study as a reason to pick up the phone and begin a relationship.

When you read the study (it is not difficult to understand), you will find many points that can be made; here are a few to start with:

  • The study demonstrates unequivocally that for “low risk” mothers, home birth attended by a CPM results in outcomes comparable to low risk births in the hospital –ie CPM-attended planned home births are safe for mothers and babies.
  • Despite the fact that the midwives in the study included many who were not well-integrated into the health care system, mothers and babies that did need medical attention were appropriately identified and transported to hospitals and got the care they needed; otherwise, we would not see the good outcomes that are comparable to hospital birth outcomes.
  • Substantially fewer interventions were performed on mothers planning home births than on comparable mothers giving birth in hospitals, which suggests that many of those interventions are unnecessary. Such unnecessary interventions are costly and are associated with increased complications for mothers and babies.

Overall, the study shows that for healthy women, a planned home birth with a trained midwife (ie, a CPM), is a safe and reasonable choice for maternity care, supported by the evidence.  If maternity care is “scientific” women everywhere should have access to midwives and out-of-hospital birth.

You are welcome to post this grassroots network message in its entirety to other e-lists you may be on.  You may also forward either or both of the press releases to anyone.

Sincerely,
Susan Hodges,  “gatekeeper”

Susan Hodges is the president of Citizens for Midwifery
http://www.cfmidwifery.org/
Athens, Georgia
[email protected]

 

Press Release from BMJ 

Planned home births in the United States are safe, say researchers

Outcomes of planned home births with certified professional midwives: large prospective study in North America BMJ Volume 330,

Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week’s BMJ.

Midwives involved with home births are often not well integrated into thehealthcare system in the United States and evidence on the safety of suchhome births is limited. In the largest study of its kind internationally to date, researchers analysed over 5000 home births involving certified professional midwives across the United States and Canada in 2000.

Outcomes and medical interventions were compared with those of low risk hospital births.

Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America. A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions,” say the authors. “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.”

Contact:

Kenneth Johnson, Senior Epidemiologist, Surveillance and Risk AssessmentDivision, Center for Chronic Disease Prevention and Control, Public HealthAgency of Canada, Ottawa, CanadaTel: +1 613 957 0339

To arrange an interview, please call Aggie Adamczyk: +1 613 941 8189 (Public Health Agency media contact)

Email: [email protected]

Betty-Anne Daviss, Project Manager, FIGO Safe Motherhood/Newborn Initiative, Housed at The Society of Gynaecologists and Obstetricians of Canada, 780 Echo Drive, Ottowa, Canadatel: +1 800 561 2416  OR  +1 613 730 4192 Ext. 263

Email: [email protected]

Further Information from co-author Betty-Anne Daviss:

The British Medical Journal has embargoed a press release until tomorrow (up on their website at bmj.org) regarding the largest study ever done of its kind on home birth. What the press release does not point out is that it was conducted by two Canadian researchers who live in Ottawa — a Canadian epidemiologist and a Canadian midwife.  

It was carried out on all clients having a delivery with a certified professional midwife for a given time period and reports on 5,418 births.

 The majority of the births were done by American midwives but Canadian midwives were also included in the study. 

The study shows that — if you aren’t a high risk Mom carrying twins, having a premature baby or baby coming bottom first, all of which can be judged ahead of time — your chance of having a healthy normal safe delivery are the same whether you plan a home or hospital birth. However, if you choose the home birth your intervention rates will be a tenth to a half of what they would be in hospital, compared to figures of the same time period from the National Health Institute of the US

The study is groundbreaking because former studies have been criticized for not being big enough, for not being able to distinguish between planned or unplanned births, and for being retrospective, that is only looking at old records as opposed to engaging health professionals in the requirement of registering births they were going to do and then having to account for all outcomes. As well, over 500 mothers were phoned to verify whether what the midwives said at the births actually happened. 

The study suggests that legislators and policy makers should pay attention to the fact that this study supports the American Public Health Association resolution to increase out of hospital births done by direct entry midwives.

 The American College of Obstetricians and Gynecologists still opposes home birth. The SOGC has written a statement acknowledging that women have the right to choose their place of birth.  Betty-Anne Daviss, Registered Midwife
co-principal investigator of the study