This large and exciting study demonstrates that midwifery care with different types of midwives is an option for healthy women with low-risk pregnancies including women carrying their first child. Women need to understand the differences in types of midwives available to them and choose their birth attendant carefully. Home birth is safest when there is good communication between the midwife/birth attendant and hospital. Unfortunately, It is not uncommon to find financial/political competition between physicians and midwives. EMTALA, the Emergency Medical Treatment & Labor Act, prevents hospitals or staff from refusing to care for someone who arrives at their doors in labor or in an emergency but a poor relationship with hospital staff can result in dangerous delays to care.
This study of almost 17,000 births was published in the American College of Nurse-Midwives professional journal but the births were attended by a variety of different types of midwives. Nurse-Midwives are the most highly researched midwives in the U.S but most attend births in hospitals but other types of midwives mostly do homebirths and are therefore specialists in this arena. The majority of the study’s pregnant women were white, college educated, married and paid for their services out of pocket so this does not represent the general population and better outcomes were to be expected. Interestingly 6% were Amish or Mennonite who have very healthy lifestyles.
This study, using a variety of different types of midwives included some high-risk pregnancies as noted below. The summary of their results follows:
- 89% of the births were successful at home
- The hospital transfers during labor were primarily for “failure to progress” which means labor stalled and the many midwife interventions were unable to get it to advance.
- Less than 5% of women required, at the hospital, artificial stimulation of their labor or epidural anesthesia.
- 94% of women had a normal vaginal birth
- 1% had an assisted vaginal birth (forceps or vacuum)
- The cesarean rate was only 5.2%.
- 1054 women attempted a vaginal birth after a cesarean with an 87% success rate. (Be advised that VBAC at home is a controversial topic and there were increased rates of fetal but not neonatal death with these women in this study).
- Included preterm (less than 37 weeks), breech, multiple gestations including twins, gestational diabetes and preeclampsia. (Be advised it is controversial if these births should be done at home and this study showed evidence that fetal/newborn death was higher in some of these situations).
- 49% had intact perineums (no tearing).
- Expected very low rates of medical interventions
- Apgar scores (score of newborn condition) of less than 7 at 5 minutes occurred in 1.5% of babies. (Which also happens in hospital births).
- 97% of babies in this study were carried full term and weighed an average of eight pounds at birth
- 98% were being breastfed at the six-week follow-up visit
- Only 1% of babies needed to be transferred to a hospital after coming into the world.
Previous studies used less than ideal birth certificate data which doesn’t identify the crucial information if the home birth was planned or not. This study utilized data from the Midwives Association of North America data sets that provided more detail. Hopefully this research will encourage the states that have not made homebirth a legal option (can you believe some states don’t give women the legal option to give birth at home?) the impetus to do so. Homebirth is also much less expensive which leads to savings for all of us. Evidence continues to amass that homebirths for normal pregnancies may yield health benefits far after the birth. The Cesarean rate was dramatically reduced and this study also seems to indicate that higher risk women are not ideal candidates for homebirth.
Cheyney, M. (2014, January 30). Journal of Midwifery & Women’s Health. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract