Evidence

Evidence Regarding the Practice of Certified Professional Midwifery & Home and Birth Centers Settings for Birth

Home Birth: An Annotated Guide to the Literature; Vedam S, Schummers L, Stoll K, Fulton C; September 2012.
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This bibliography is offered as a resource for clinicians and others (researchers, educators and policy makers)who must, within their own context for work, assess the quality of the available evidence on planned home birth,for the purpose of clinical decision making or to contextualize the current international debate on safety, access ethics, autonomy, and resource allocation with respect to birth place.

National Research Council. An Update on Research Issues in the Assessment of Birth Settings: Workshop Summary. Washington, DC: The National Academies Press, 2013.
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More than 30 years ago, the IOM and the National Research Council released the report Research Issues in the Assessment of Birth Settings which determined methodologies and research needed to evaluate childbirth settings in the United States. Since the release of the report in 1982, the issues surrounding birth settings have evolved. The demographic and health trends of childbirth have changed; birth setting trends have changed, including a growing but still very small percentage of women choosing to deliver at home; more and different types of data are available now than were available 30 years ago; and researchers are asking different questions than they did three decades ago.

On March 6-7, 2013, the IOM held a workshop to review updates to the 1982 report. Presentations and discussions highlighted research findings that advance understanding of the effects of maternal care services in different birth settings, including hospitals, birth centers and homes; on labor, clinical and other birth procedures; and birth outcomes. The workshop also identified datasets and relevant research literature that may inform a future study. This document summarizes the workshop.

“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss. BMJ 2005;330:1416 (18 June).

This article and related letters to the editor are available online, free, at http://www.bmj.com. (Use the search feature and type Daviss for the author.) The largest study of home births attended by Certified Professional Midwives, as published in the British Medical Journal, found that home birth is safe for low risk women and involves far fewer interventions than similar births in hospitals.

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Melissa Cheyney PhD, CPM, LDM*, Marit Bovbjerg PhD, MS, Courtney Everson MA, Wendy Gordon MPH, CPM, LM, Darcy Hannibal PhD, Saraswathi Vedam CNM, MSN, RM. Journal of Midwifery & Women’s Health

Introduction

Between 2004 and 2010, the number of home births in the United States rose by 41%, increasing the need for accurate assessment of the safety of planned home birth. This study examines outcomes of planned home births in the United States between 2004 and 2009.

Methods

We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Data were analyzed according to intended and actual place of birth.

Results

Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intra-partum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively.

Discussion

For this large cohort of women who planned midwife-led home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.

Outcomes of care in birth centers: demonstration of a durable model. Stapleton SR, Osborne C, Illuzzi J. J Midwifery Womens Health. 2013 Jan-Feb;58(1):3-14. doi: 10.1111/jmwh.12003. Epub 2013 Jan 30.
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Introduction

The safety and effectiveness of birth center care have been demonstrated in previous studies, including the National Birth Center Study and the San Diego Birth Center Study. This study examines outcomes of birth center care in the present maternity care environment.

Methods

This was a prospective cohort study of women receiving care in 79 midwifery-led birth centers in 33 US states from 2007 to 2010. Data were entered into the American Association of Birth Centers Uniform Data Set after obtaining informed consent. Analysis was by intention to treat, with descriptive statistics calculated for maternal and neonatal outcomes for all women presenting to birth centers in labor including those requiring transfer to hospital care.

Results

Of 15,574 women who planned and were eligible for birth center birth at the onset of labor, 84% gave birth at the birth center. Four percent were transferred to a hospital prior to birth center admission, and 12% were transferred in labor after admission. Regardless of where they gave birth, 93% of women had a spontaneous vaginal birth, 1% an assisted vaginal birth, and 6% a cesarean birth. Of women giving birth in the birth center, 2.4% required transfer postpartum, whereas 2.6% of newborns were transferred after birth. Most transfers were nonemergent, with 1.9% of mothers or newborns requiring emergent transfer during labor or after birth. There were no maternal deaths. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 excluding anomalies.

Discussion

This study demonstrates the safety of the midwifery-led birth center model of collaborative care as well as continued low obstetric intervention rates, similar to previous studies of birth center care. These findings are particularly remarkable in an era characterized by increases in obstetric intervention and cesarean birth nationwide.