Safety

Safe Birth with Midwives in Out-of-Hospital Settings

A Healthy Newborn:
Midwives’ care supports healthy birth, growth and development, decreasing morbidity and mortality.

A Healthy Mother:
Midwives’ care supports a foundation of health beginning with the pregnancy and birth experience, and continuing throughout the mother’s lifetime.

Midwives are educated and trained as experts in the normal processes of pregnancy, childbirth, and post-partum care with healthy women.



Again and again, well-structured studies have shown that planned home or birth center birth with a direct-entry midwife is safe for low risk women.

Outcomes of Planned Home births with a Certified Professional Midwife, 2000

  • Low perinatal mortality, 1.7 in 1,000 live births (similar to hospital rates for low-risk births)
  • No maternal deaths
  • Extremely low cesarean section rate, 3.7% (hospital cesarean rate is approximately 30%)
  • Very low rates of intervention overall
  • Great rates of breastfeeding, 99% of women initiated breastfeeding

Outcomes of planned home births with Certified Professional Midwives: large prospective study in North America.
Kenneth C Johnson and Betty-Anne Daviss. British Medical Journal 2005;330:1416 (18 June).

Outcomes of planned home births with registered midwife versus attended by regulated midwives versus planned hospital birth in British Columbia, 2009

  • Low perinatal mortality in the home birth and hospital birth groups
  • Very low rates of intervention in the home birth group
  • Lower rates in the home birth group of hemorrhage, low apgar scores, and 3rd and 4th degree tears.
  • Better outcomes in the home setting versus hospital setting with the same midwives, indicating benefits of the setting itself.

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.

Even the few studies that have been used to argue against the safety of out-of-hospital birth with midwives show that midwives have excellent outcomes when the study errors are taken into account.

  • Both the Pang Study (2002) and the Wax meta-analysis (2010) mistakenly included unplanned home births and preterm births. When these unrelated numbers are taken out, the numbers in both studies actually support the safety of planned home birth with a trained midwife.

-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

-Wax JR et al. Maternal and newborn outcomes in planned home birth vs. planned hospital births: a meta-analaysis. American Journal of Obstetrics and Gynecology 2010;203(3): 243.e1-243.e8

Out-of-hospital birth with a trained midwife is a safe option for most women.  For a more extensive look at birth research click here.

 

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