31 August 2009 @ 03:43 pm
(Another) study confirms homebirth's safety  
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. Women 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
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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[identity profile] hapersmion.livejournal.com on August 31st, 2009 10:01 pm (UTC)
Yay, new study!

Good, and I see in the further text that they did match risk status for both groups, so people don't get to say that the really sick people went to the hospital and skewed the results.
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[identity profile] raving-liberal.livejournal.com on August 31st, 2009 10:07 pm (UTC)
Yes, the methodology in this one is very sound. If you read the full study results, they talk about wanting to correct for the flaws in other studies.
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[identity profile] manifestress.livejournal.com on September 8th, 2009 02:58 am (UTC)
I am soooo grateful to be living in New Mexico now where home birth is legal and common. What a refreshing difference from Georgia!

We have an awesome group of midwives in this state, and a great organization in Albuquerque - http://www.AlbuquerqueBirthNetwork.org

Edited 2009-09-08 02:58 am (UTC)
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[identity profile] raving-liberal.livejournal.com on September 8th, 2009 03:06 am (UTC)
What's the regulatory/oversight like in NM? Are midwives allowed to attend breech, twin, 42+ births?
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[identity profile] manifestress.livejournal.com on September 8th, 2009 03:15 am (UTC)
Because I'm not a midwife, I really do not know. I have many many clients who have had home births and/or are planning them. HVBACs, too.

I have several MD clients who have had home births.
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[identity profile] raving-liberal.livejournal.com on September 8th, 2009 03:15 am (UTC)
A lot of the states that certify midwives have pretty strict regulations on who they can take, or the midwives risk losing their MD backup or insurance.
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