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Home Birth With Midwife As Safe As Hospital Birth: Study

Canadian researchers find lower rate of complications

MONDAY, Aug. 31 (HealthDay News) -- Having your baby at home with a registered midwife is just as safe as a conventional hospital birth, a new study says.

In fact, planned home births of this kind may have a lower rate of complications, according to the study published in the Sept. 15 issue of CMAJ.

Even though the study was conducted in Canada, where attitudes toward midwifery are more accepting than in some other countries, the findings may help to calm an ongoing controversy in the United States and elsewhere.

The American College of Obstetricians and Gynecologists is opposed to home births, as are certain organizations in Australia and New Zealand. More organizations in Great Britain are supportive and Canadian provinces are currently transitioning to midwifery, said study lead author Patricia Janssen, director of the Master of Public Health Program at the University of British Columbia.

Janssen, a registered nurse who has midwife training though not certification, said: "People who function as independent midwives are not necessarily tightly regulated [in the U.S.] depending on which state you're in, so there may not be a guarantee that they have had an adequate level of training or a certified diploma or anything like that. And they may not be monitored and regulated by a particular professional college."

The controversy has resulted in a lack of clear regulation and licensing requirements in the United States, said Dr. Marjorie Greenfield, associate professor of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland.

According to Greenfield, the National Association of Certified Professional Midwives does have a certification process but many states don't recognize it. "If you're a woman who wants to have a home birth, how do you determine if this person has appropriate qualifications?" she said.

The authors of the new study compared three different groups of planned births in British Columbia from the beginning of 2000 to the end of 2004: home births attended by registered midwives (midwives are registered in Canada), hospital births attended by the same group of registered midwives, and hospital births attended by physicians. In all, the study included almost 13,000 births.

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.

Janssen said she hoped "this article will have a major impact in the U.S." But there is a definite "establishment" bias against home births. And the issue is an emotionally charged one, she said.

"There is a political and economic issue about controlling where birth happens, but also a deep belief by physicians that it's not safe to have your baby at home," Greenfield said. "Doctors see every home-birth patient who had a complication, but we don't see the ones that have these beautiful, fabulous babies at home who may breast-feed better or have less hospital-acquired infections. There may be medical benefits," she added.

"Midwifery needs to be regulated. It can't be under the radar because then it's dangerous," Greenfield said. "There has to be a regulatory process and a licensure process [to protect] women who are going to choose home birth anyway."

More information

Visit the National Association of Certified Professional Midwives to learn more about this specialty.

SOURCES: Patricia Janssen, R.N., Ph.D., director, Master of Public Health Program, and associate professor, University of British Columbia, Canada; Marjorie Greenfield, M.D., associate professor of obstetrics and gynecology, University Hospitals Case Medical Center, Cleveland; Sept. 15, 2009, CMAJ

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