The Sept 15, 2009 Canadian Medical Association Journal has published
a study on planned home birth which confirms (yet again) its safety and benefits for low risk pregnant women attended by skilled midwives.
Based on nearly 13,000 healthy, low-risk pregnant women, all of whom met eligibility criteria for home birth, it compared
outcomes for those who planned a home birth with a midwife, a hospital
birth with the same midwives, or a hospital birth with a physician.
All 2899 planned home births in British Columbia over the 5 year period
2000 to 2004 were included. Women who had one previous cesarean but were otherwise healthy were considered eligible for
home birth. The hospital birth comparison groups were
matched with the home birth mothers by age, number of previous births, weight, smoking, drug use, income and marital status.
To reduce possible disparities in outcomes based on serving different populations, the physician-attended comparison group were patients in
the same hospitals where the midwives also practiced. Canada has single-payer universal health coverage, so lack of prenatal care is not an issue.
The perinatal mortality rate (stillbirths after 28 weeks of pregnancy plus deaths in the first four weeks of life) were very low and comparable in all three groups:
0.35 per 1,000 in the planned home birth
group, 0.57 in hospital births attended by midwives, and 0.64 among
those attended by physicians.
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Women in the planned home birth group were less likely to have medical interventions including electronic fetal monitoring, augmentation of labor,
and episiotomy. They had fewer complications such as post partum hemorrhage, infection or serious perineal tears. Their babies were less likely to need oxygen therapy or resuscitation at birth.
Statistics for the home birth group included the 21% of women who planned to deliver at home
but were transferred to hospital after labor began. This is important because it shows that
women who begin labor at home have excellent outcomes even if they require hospitalization before delivery.
The planned home birth group had a spontaneous vaginal delivery rate of 89.9% compared to 75.2% for
physician patients. The cesarean section rate for women having a first baby in the planned home birth group was
13% compared to 21.8% for first-time mothers cared for by physician.
Canada requires that all midwives must attend both
home and hospital births, but home birth is outside the scope of practice
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