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Homebirth/midwifery safety studies.

"Outcomes of Elective Home Births: A Series of 1,146 Cases" by Lewis Mehl, M.D. et al. Journal of Reproductive Medicine. November, 1977.

This study evaluates 1,146 homebirths that occurred in California. Sixty percent of these births were attended by doctors or nurses and forty percent by lay midwives. There is no difference in outcomes between the two groups. The rate of complications at the births is very low compared to California hospital birth averages. The mortality rates are less than half the hospital rates and the C-section rate is 2.4% (the current U.S. cesarean rate is 28%).

"Neonatal Outcomes in Planned vs. Unplanned Out-of-Hospital Births in Kentucky" by M. Ward Hinds, M.D., M.P.H. et al. Journal of the American Medical Hospital Association. March 15, 1985.

This study surveys incidence of neonatal mortality and low birth weight in out-of-hospital births. It divides the 809 births surveyed into two groups: 575 planned homebirths and 234 unplanned. The planned homebirths were attended by direct entry midwives. The study concludes that although unplanned homebirths have a significantly higher incidence of low birth weight and neonatal mortality, the planned homebirths have lower incidence of both low birth weight and mortality than do Kentucky hospital births attended by physicians.

"Neonatal Mortality in Missouri Home Births, 1978-84" by Wayne F. Schramm, M.A. et al. American Journal of Public Health. August 1987.

This study examines 4,054 Missouri homebirths, planned and unplanned. The births were attended by a variety of caregivers: physicians, certified nurse midwives, direct entry midwives and "others". The study concludes that for planned homebirths "no important difference" is found in neonatal mortality compared to hospital births. The authors note that the Missouri Midwives Association certified midwives have the best outcomes of all the attendants in the study, including physicians.

"Having Babies at Home: Is It Safe? Is It Ethical?" by Gerald Hoff, M.D. and Lawrence Schneiderman, M.D. Hastings Center Report. December, 1985.

This essay examines the ethical dilemma posed to the physician by homebirth. Many physicians vigorously oppose homebirth, and the authors examine the available data to determine whether this opposition is ethical. They conclude that "homebirth does not present a clear and present danger..." They suggest that since homebirth is reasonably safe, it should not be prohibited.

"The Statistical Case for Elimination of the Midwife: Fact versus Prejudice, 1890-1935 by Neal Devitt, B.A. (now M.D.) Women and Health. Volume 4, 1979.

This article gives a clear history of how the profession of midwifery in the U.S. was almost obliterated by obstetricians despite statistical evidence that the midwives were having better outcomes than the physicians. The author shows that the same problems with rural and indigent care existed then as they do now and points clearly to direct entry midwifery as the solution.

"Evaluation of Outcomes on Non-Nurse Midwives. Matched Comparisons with Physicians" by Lewis Mehl, M.D. et al. Women and Health, Vol. 5, 1980.

This study compares matched populations of homebirths attended by non-nurse midwives with hospital births attended by physicians. It concludes that the midwife sample has significantly better maternal and neonatal outcomes and attributes this fact to physicians' high rate of intervention.
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Author:Braun, Jennifer
Publication:Special Delivery
Date:Mar 22, 1992
Previous Article:Homebirth as the standard of care.
Next Article:Advantages of homebirth.

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