Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) Online Appendix Résumé Correction Correction (v182,p65) Correction (v181,p617) All Versions of this Article: cmaj.081869v1 181/6-7/377    most recent Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Janssen, P. A. Articles by Lee, S. K. Search for Related Content PubMed PubMed Citation Articles by Janssen, P. A. Articles by Lee, S. K. Related Collections Other obstetrics & gynecology Related Articles

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

From the School of Population and Public Health (Janssen), the Departments of Family Practice (Klein) and Obstetrics and Gynecology (Janssen, Liston) and the Division of Midwifery (Saxell), Faculty of Medicine, University of British Columbia, Vancouver, BC; the Child and Family Research Institute (Janssen, Klein, Liston), Vancouver, BC; the Nightingale School of Nursing and Midwifery (Page), King’s College, London, UK; the Department of Pediatrics (Lee); and the Integrated Centre for Care Advancement Through Research (Lee), University of Alberta, Edmonton, Alta.

Correspondence to: Dr. Patricia A. Janssen, School of Population and Public Health, University of British Columbia, 5804 Fairview Cres., Vancouver BC V6T 1Z3; fax 604 806-8006; pjanssen{at}interchange.ubc.ca

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. Women 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 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.

This article has been cited by other articles:

				Correction: Research Can. Med. Assoc. J., January 12, 2010; 182(1): 65 - 65. [Full Text] [PDF]

				E. F. Barros Smoking status and planned hospital births Can. Med. Assoc. J., November 10, 2009; 181(10): 716 - 716. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2009, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.