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Janssen, Saxell, Page, Klein, Liston, & Lee.  (2009).  CMAJ, 181(6-7), 377-383.

The authors concluded that the decision to plan a birth attended by a registered midwife at home versus in the hospital was associated with very low and comparable rates of perinatal death.  Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician.  Newborns whose mothers planned a home birth were at similar or reduced risk of fetal and neonatal morbidity compared with newborns whose mothers planned a hosptial birth, except for admission to hospital, which was more likely compared with newborns whose mothers were in the physician-attended cohort.

The strengths of this research article is that both home and hospital births were attended by the same cohort of midwives, offering a true comparison of planned place of birth unconfounded by type of caregiver.  The study adds to the body of large cohort studies of planned home births that have reported on the relative safety of home versus hospital births. 

This research should add confidence to the safety of home birth in a context such as Canada's in which registered midwives have a baccalaureate degree or equivalent and are an integral part of the health care system.  These findings do not extend to settings where midwives do not have extensive academic and clinical training.

Jonge, A., van der Goes, B.Y., Ravelli, ACJ., Amelink-Verburg, MP., Mol, BW., Nijhuis, JG., Gravenhorst, JB. & Buitendijk, SE. 2009. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.  BJOG, 107. 

BJOG An international Journal of OBstetrics and Gynaecology

"In this large cohort study, planned home birth in a low-risk population was not associated with higher perinatal mortality rates or an increased risk of admission to a NICU compared to planned hospital birth after controlling for maternal characteristics."

"This study has some major strengths.  As far as we know, this is the largest study into the safety of home birth.  Its large sample size provided the power to detect differences in rare adverse outcomes.  As it has been shown that conducting a randomised controlled trial is not possible, the best evidence about the safety of home birth can only come from good quality, routine registrations such as the one we used in our study.  Furthermore, we were able to study a group of truly low-risk women."

The authors stress however, that the safety of homebirth is dependent on maternity care systems that support this choice and attendance by well-trained midwives who assess the appropriateness of a home birth and through a rapid transportation and an integrated referral system.

Boucher, D., Bennett, C., McFarlin, B., & Freeze, R.  (2009).  Staying home to give birth: why women in the United States choose home birth.  Journal of Nurse Midwifery, 54(2), 121-126.

This study describes the reasons that women in the United States choose home birth.  Women were asked, "Why did you choose home birth?"  The most common reason given for wanting to birth at home was safety. 

Revised guidelines on when and how to induce labor in pregnant women were issued recently by The American College of Obstetricians and Gynecologists (ACOG). The guidelines provide physicians with guidance regarding which induction methods may be most appropriate under particular circumstances, as well as the safety requirements, and risks and benefits of the different methods.  Most importantly, ACOG states induction should not occur prior to 39 weeks or verification of fetal lung maturity, which differs from its previous recommendation of 37 weeks.  Midwives are once again proven to have a safer standard of care!

Murphy PA, Fullerton J. (1998). Obstet Gynecol, 92(3): 461-70.

Conclusion: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary.  Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage.

The maternal health care crisis in the United States by the Amnesty International. Health is a human right.

Summary of critical points by Peter F. Schlenzka

Doctoral thesis comparing safety and costs of natural out-of-hospital birth with in-hospital obstetric births. He finds out-of-hospital births to be slightly safer and significantly superior in terms of economic costs ($13 billion annually) and social costs (reduced incidence of birth trauma and bonding disorders).

Compiled by Michael J. Stark, Ph.D. for the Maryland Friends of Midwives.

Citizens for Midwifery Fact Sheet

Healthy women with qualified care providers, usually midwives, can have safe home births.

Judity A Lothian, PhD, Rn, LCCE, FACCE

In spite of technology and medical science's ability to manage complex health problems, the current maternity care environment has increased risks for healthy women and their babies.  It comes as a surprise to most women that standard maternity care does not reflect best scientific evidence.  In this article, evidence-based maternity care practices are discussed with an emphasis on the practices that increase safety for mother and baby, and what pregnant women need to know in order to have safe, healthy births is described.

"All infants exposed to vacuum assisted delivery devices will have a caput succedaneum" - FDA 1998.

"Cephalohematoma or significant bruising" is a 'major risk factor' for hyperbilirubinemia and kernicterus" - AAP 2004.