Once again, Science proves what Nature knows

Last week a study was published out of Canada comparing homebirth rates with midwives to hospital births with midwives and physicians. What is so good about this study is that is compares and compares and compares (three times because of the three factors it studies!). The study carefully looks at outcomes among Canadian women over four years within a common health care system, which means that in general these women can be compared. Also important to the study is that those who birthed at home had planned to do it- it wasn't an accident. The results show, as you will read below, that results of midwives are comparable to those of a physician. If you read the results of the study you will find that the results of the midwife attended homebirth are BETTER. Not just similar, B.E.T.T.E.R. This includes perinatal mortality (who new? in fact it appears in Canada LESS babies die at home). Homebirths also incurred LESS interventions (thats a no-brainer) or adverse maternal outcomes, which are defined as third and fourth perineal tear and post partum hemorrage.

So my question is- if the midwives are proving far better outcomes consistently then why is the research so controversial? Is it because women still have to work three times as hard to get half the recognition? Why is it that women's choice in birth is so controversial and questioned? Why is it that so few Maternal Health organizations recognize the Midwifery Model of Care?

How ss it that if midwives have BETTER outcomes than physicans, they are COMPARABLE?

If physicans had better outcomes than midwives than wouldn't they be deemed safer? So why doesn't someone just stand up and say it? OK, I will....

HAVING YOUR BABY AT HOME WITH A MIDWIFE IS SAFER THAN HAVING IT AT THE HOSPITAL.

GOT IT??????

now, read the study! and congratulate the authors, they did a fantastic job.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A Janssen ¹, Lee Saxell ², Lesley A Page ³, Michael C Klein ⁴, Robert M Liston ⁵, Shoo K Lee ⁶

¹ School of Population and Public Health, the Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
² Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
³ Nightingale School of Nursing and Midwifery, King's College, London, UK
⁴ Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁵ Department of Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute, Vancouver, BC
⁶ Department of Pediatrics and the Integrated Centre for Care Advancement Through Research, University of Alberta, Edmonton, Alta.

	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. Wo men 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 Abstract 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.