Largest Analysis of Planned Home Birth in the U.S. Ever Published

Two articles on home birth data and outcomes in the United States are available to read online. The Journal of Midwifery and Women’s Health is providing free online access to the full content of both articles for this year:

Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, & Vedam S. Outcomes of care for 16,984 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004-2009http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract

Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, & Vedam S. Development and validation of a national data registry for midwife-led births: The Midwives Alliance of North America Statistics Project 2.0 dataset.http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12165/abstract

For the women described in this study (N=16,924), the findings included:

  • low rates of cesarean birth (5.2% for planned home vs a national average of 31% for term infants)
  • low rates of birth assisted by forceps or vacuum (1.2% for planned home vs. a national average of 3.5%)
  • low rates of episiotomy (1.4% for planned home vs a national average of about 25%)
  • less need for oxytocin to speed labor (4.5% for planned home vs national average of 40% for labor induction & augmentation in term pregnancies)
  • less use of epidural analgesia (4% for planned home vs a 67% national epidural rate)

Among these women who planned a home birth with a midwife, their babies were at very low risk for:

  • being born prematurely (2.5%)
  • being born too small (<1%)
  • having a low 5-minute Apgar score (1.5%)
  • requiring a transfer to a hospital after being born at home (1%)
  • not being breastfed (0.4% planned home vs  24% planned hospital at hospital discharge)

Intrapartum deaths of babies – national data not available

  • Intrapartum  Deaths that occurred in the entire sample, regardless of risk factors. When all deaths were examined (excluding babies with lethal congenital anomalies, but including higher-risk factors), approximately 1.3 babies per 1000 planned home births died in labor;
  • Intrapartum Deaths that occurred among low risk women  .85 per 1000

Neonatal Deaths

  • 0.4 babies per 1000 live births died in the first week of life;  National data 0.46/1000
  • 0.35 babies per 1000 live births died in the first month of life. ; national data 0.33/1000

This study was not able to make direct comparisons with a matched hospital cohort of women with similar risk. Authors looked at aggregate national data from the CDC. 

According to the authors, neonatal death rates are similar and slightly better than the overall national statistics for term births, while the intrapartum death rate is slightly higher.

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