Annotated Bibliography of US Research on Midwifery and Out-of-Hospital Childbirth

*Cawthon L. Planned home births: outcomes among Medicaid women in Washington State. Olympia,WA: Washington Department of Social and Health Services; 1996.

This review of perinatal data for 2,054 Medicaid women who were cared for by licensed midwives found no significant difference in mortality rates with matched hospital births.

*Durand, A.M. The Safety of Home Birth: The Farm Study. Am J Public Health, 1992;82:450-452

This study showed extremely low rates of cesarean section and complications for women cared for by direct-entry midwives. There was no increased risk of infant or maternal morbidity or mortality.
*Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee Sk. Outcomes of planned home births with registered midwife versus attended by regulated midwives versus planned hospital birth in British Columbia. Canadian Medical Association Journal, 2009 181(6): 377-383.

This study affirmed the safety of planned home birth with midwives, showing a low perinatal mortality rate as well as low rates of cesarean section and other interventions. The home birth group also had lower rates of hemorrhage, low apgar scores, and 3rd and 4th degree tears. Additionally the study showed better outcomes in the home setting versus hospital setting with the same midwives, indicating benefits of the setting itself.
*Johnson K, Daviss BA. Outcomes of planned home birth with certified professional midwives: large prospective study in North America. British Medical Journal 2005;330;1416

This large and well-structured study showed clearly that home birth with a Certified Professional Midwife (CPM) is safe for low-risk women. The perinatal mortality rate was comparable to the hospital and the rate of cesarean section (3.7%) and other interventions were very low.
*Pang J, Heffelfinger J, Huang G, Benedetti T, Weiss N. Outcomes of planned home births in Washington state: 1989-1996. Obstetrics & Gynecology. 2002;100(2):253-259

This study is often used to argue that out-of-hospital birth is unsafe but its poor study structure makes this assertion meaningless. The study mistakenly included unplanned as well as pre-term home births. For a detailed critique of the Pang study see: Vedam, S. Home versus hospital birth: questioning the quality of the evidence on safety. Birth 2003, 30(1), 57-63.
*Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis. Am J Obstet Gynecol 2010;203

This flawed meta-analysis concluded that home birth carried a higher risk of neonatal mortality. The authors included several primary research papers in the meta-analysis that included unplanned, unattended home births, had differing definitions of “neonatal mortality,” or were non-randomized and unmatched studies. For a more complete critique of the Wax meta-analysis see: Gyte G, Newburn M, Macfarlane A. Critique of a meta-analysis by Wax and colleagues. National Childbirth Trust July 7, 2010

For additional research sources we recommend visiting the Mothers Naturally website or reading through this more extensive guide to birth literature.

More information on the safety of homebirth is available here.

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