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Outcomes of planned home births with
certified professional midwives: large prospective study in North America
Kenneth C
Johnson, senior
epidemiologist1, Betty-Anne Daviss,
project manager2
1 Surveillance and Risk Assessment Division, Centre
for Chronic Disease Prevention and Control, Public Health Agency of
Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe
Motherhood/Newborn Initiative, International Federation of Gynecology and
Obstetrics, Ottawa, Canada
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.
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