Home Birth With Midwife As Safe As Hospital Birth: Study

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US News did a nice job, better than many other articles of similar content. Amy, even US CNM's do not get trained in homebirth AND hospital birth. I applaud the Canadian Health system for designing a birth model that allows Midwives to attend women in either birth setting, according to the woman's choice. The UK, Netherlands, and other countries approach birth in the same way and their excellent statistics reveal how successful that can be. American Certified Professional Midwives do have equal training to American Certified Nurse-Midwives, in midwifery. The North American Registry of Midwives website explains all that,....check it out. What they do NOT have is years spent learning the medical model of anything. CNM's typically enter midwifery school after having been a nurse, and worked in various areas of nursing, before deciding to enter the field of midwifery. Professional Midwives typically enter into midwifery as their first and primary passion, after years of time around birthing women. The CPM training model is a shining example of how to acquire education and skills training in ways the ACNM could only dream of. I might add that if OB's hadn't been so aggressive at wiping out ALL midwifery all these past decades, an integrated approach to educating them would have emerged, but they'll have none of that. They already are permitted to limit CNM's in ways they shouldn't. Moms, beware! OB's make decisions about your and your baby's health based on litigation-driven assumptions, not your health's best interest. More than another other area of medicine, Obstetrics is ridden with a wake of bad practices that were eventually abandoned. Which of today's current protocols, 20-30 years from now, will be phased out? Remember DES, twilight sleep, full shaves, and a host of others? (Go ask your mother/grandmother!) Let's get rid of: eating restrictions, immediate cord cutting, pushing on your back, pitocin inductions, there's just not enough ROOM!!! Midwives already practice evidence-based maternity care. IT's BETTER FOR MOMS AND BABIES!!! Try it Dr. Amy, your patients would like it.

clementine of IL 9:56AM September 04, 2009

It's wonderful to see Amy Tuteur state publicly that homebirth is safe!
Of course, she can't help slamming American midwives using voodoo statistics that neither the authors nor the peer reviewers of the study she references recognize. That study, too, showed excellent/equivalent morbidity and mortality outcomes for homebirth - in America, with CPMs - but was suppressed by the ACOG.
Both Greenfield and Tuteur disingenously mention difficulties with consistent training and licensure standards for American midwives without admitting the direct cause: American obstetricians, unlike most of their counterparts in our peer nations, have pursued a vendetta against homebirth midwives and a monopoly on birth services. The campaign has been vicious, shameless, and sustained.
If the AMA and ACOG were really motivated by safety, they would be supporting consistent training and licensure standards nationally and collaborating seamlessly with qualified homebirth midwives, not trying to outlaw homebirth!
American women are being lied to. There is a better option for most women, and the ACOG and AMA know they can't compete on safety or patient satisfaction. Find out the legal situation in your state and let your representatives know you will not tolerate the ACOG's anticompetitive practices.

Dana of OH 10:21AM September 01, 2009

Certified Professional Midwives are the only maternity care providers in the U.S. whose specialized training prepares them for out-of-hospital births.
As OBs leave rural communities to serve in the growing exurbs, community hospitals close their L&D units, and increasing numbers of families face the need for care without insurance coverage, CPMs are stepping into the gap to provide skilled, evidence-based, culturally competent care at a fraction of the cost.
Additionally, the model of care that CPMs is being demonstrated to substantially decrease the rates of pre-term labor and low-birth weight babies in communities at increased risk for disparities in outcomes.
I absolutely support the drive to provide for a legal framework for CPMs to practice within and am working wholeheartedly to see that happen in my own home state.

Stephanie BB of OH 11:53PM August 31, 2009

"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."
Homebirth in Canada is strictly regulated and midwives have far more education and training than American homebirth midwives. This is directly reflected in the statistics for American homebirth midwives. According to the CDC, in 2003-2004 the mortality rate per 1000 births for planned homebirths attended by an American homebirth midwife was 1.15. That's more than triple the death rate for homebirth in Canada.
American homebirth midwives do not meet the standards for American nurse midwives, Canadian midwives, European midwives, Australian midwives or midwives anywhere in the industrialized world. Homebirth in the US will not be safe until American homebirth midwives are held to the same standards as Canadian midwives.

Amy Tuteur, MD of MA 10:04PM August 31, 2009

I'm so happy to see scientific studies that cut through the hysteria around the homebirth debate. Planned homebirths with qualified midwives can be a terrific option for low-risk pregnancies. Obstetrics, as currently practiced in America, is often not evidence-based -- interventions such as continuous fetal monitoring, epesiotemies, aggressive use of Pitocin and directed pushing tend to do more harm than good, but they're standard fare in delivery rooms. That's one of the reasons why the American C-section rate is a jaw-dropping 32 percent. Sure, there are some risks at home, which is why you want a highly trained and experienced midwife there with you to identify when a swift hospital transfer is appropriate. Midwifery needs to be regulated, not forced underground. Most women will choose to delivery in hospitals, but those who want a homebirth deserve the option of midwife who has been officially certified. Next step -- increasing insurance coverage for homebirth, which costs on average abotu $2,500 rather than $7,500 for an uncomplicated vaginal delivery in a hospital.

Jen of TX 3:44PM August 31, 2009