Yet another large study, just published in the Canadian Medical Association Journal, demonstrates the safety of planned, midwife-attended home birth!
In the abstract, the authors conclude:
“Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.”
The new Canadian study compares outcomes for planned midwife-attended home births, planned midwife-attended hospital births (with the same cohort of midwives), and planned physician-attended hospital births. The women in all three groups all met the requirements to be eligible for a home birth, so the study groups are as comparable as possible.
The study used data from one health region in British Columbia. Canadian midwives practice in both home and hospital settings, which allowed a comparison of midwife-attended home and midwife attended hospital birth where ONLY the setting was different.
There are many interesting facts, data and observations in this study which is well worth reading!
You can read the abstract and the complete article (the early-release version) at:
http://www.cmaj.
Sincerely,
Susan Hodges, “gatekeeper”
Note from Molly: The ever-informative and intelligent Science and Sensibility blog took an in-depth look at this study in this post. A particularly good point that Amy made about the new study was "3. The researchers isolated the effect of the birth setting itself by comparing midwife-attended home birth with midwife-attended hospital birth. In fact, the same group of midwives cared for women in both settings, so differences are likely to be related to the setting and its protocols and technological accoutrements (or lack thereof) rather than differences in the providers who actually provide the care."
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Early release, published at www.cmaj.ca on August 31, 2009. Subject to revision.
Outcomes of planned home birth with registered midwife
versus planned hospital birth with midwife or physician
Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD,
Robert M. Liston MD, Shoo K. Lee MBBS PhD
ABSTRACT
Background: Studies of planned home births attended by
registered midwives have been limited by incomplete
data, nonrepresentative sampling, inadequate statistical
power and the inability to exclude unplanned home
births. We compared the outcomes of planned home
births attended by midwives with those of planned hospital
births attended by midwives or physicians.
Methods: We included all planned home births attended
by registered midwives from Jan. 1, 2000, to Dec. 31, 2004,
in British Columbia, Canada (n = 2889), and all planned
hospital births meeting the eligibility requirements for
home birth that were attended by the same cohort of midwives
(n = 4752). We also included a matched sample of
physician-attended planned hospital births (n = 5331). The
primary outcome measure was perinatal mortality; secondary
outcomes were obstetric interventions and adverse
maternal and neonatal outcomes.
Results: The rate of perinatal death per 1000 births was
0.35 (95% confidence interval [CI] 0.00–1.03) in the group
of planned home births; the rate in the group of planned
hospital births was 0.57 (95% CI 0.00–1.43) among women
attended by a midwife and 0.64 (95% CI 0.00–1.56) among
those attended by a physician. Wo men in the planned
home-birth group were significantly less likely than those
who planned a midwife-attended hospital birth to have
obstetric interventions (e.g., electronic fetal monitoring,
relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal
delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes
(e.g., third- or fourth-degree perineal tear, RR 0.41,
95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95%
CI 0.49–0.77). The findings were similar in the comparison
with physician-assisted hospital births. Newborns in the
home-birth group were less likely than those in the midwife-
attended hospital-birth group to require resuscitation
at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy
beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings
were similar in the comparison with newborns in the
physician-assisted hospital births; in addition, newborns in
the home-birth group were less likely to have meconium
aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to
Abstract be admitted to hospital or readmitted if born in hospital
(RR 1.39, 95% CI 1.09–1.85).
Interpretation: Planned home birth attended by a registered
midwife was associated with very low and comparable
rates of perinatal death and reduced rates of obstetric
interventions and other adverse perinatal outcomes compared
with planned hospital birth attended by a midwife
or physician.
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