Home births are common in much of the world, where midwives provide the bulk of prenatal care and assist with delivery. But in the United States, home births remain controversial, and about 99 percent of expectant moms give birth in a hospital. Those who promote home births emphasize the social, cultural, and emotional benefits of the practice. Yet many medical providers express concern that the lack of immediate access to a hospital's services may endanger the lives of both mom and child. Canadian researchers investigated whether planned home births attended by certified professional midwives are as safe as low-risk hospital births.

What the researchers wanted to know: Are planned home births attended by certified professional midwives safe?

What they did: Researchers enrolled more than 5,000 expectant moms who were planning to have home births attended by certified professional midwives in 2000. Several hundred midwives who attended these births documented details about the course of caring for their patients, including any complications they encountered. Researchers also randomly contacted about 10 percent of the moms to evaluate patient satisfaction and validate the outcomes that midwives reported. They then compared their data with those documented for low-risk hospital births in the United States in 2000.

What they found: Researchers found similar mortality rates for low-risk hospital births and planned home births. They also noted that moms hoping to have a home birth were less likely to have medical interventions like caesarean sections or forceps delivery. About 12 percent of women intending to give birth at home needed to be transferred to the hospital for reasons such as a difficult labor or pain relief. More than 97 percent of such moms were very pleased with their overall care.

What it means to you: In low-risk situations, home births attended by certified professional midwives may be just as safe as hospital births. A birth's risk depends on several factors, including the position of the baby, the due date, the mother's age, and her medical and pregnancy history. Expectant parents should discuss the risks and benefits of a home birth with their medical provider.

Caveats: The authors point out that the demographics of those planning home births were quite different from those who opted for a hospital. Those who delivered at home tended to be older, more educated, of lower socioeconomic classes, and less likely to be African-American or Hispanic. They also were more likely to have given birth to a child before. Additionally, women who choose to give birth at home may be different in ways that the study did not recognize. For example, women hoping for a home birth may be particularly confident about not needing significant medical assistance during labor. One should be cautious in applying the study results to all expectant moms.

Find out more: The American College of Nurse-Midwives has a page with information on midwifery and home births.

Read the article: Johnson, K.C., et al. "Outcomes of Planned Home Births With Certified Professional Midwives: Large Prospective Study in North America." BMJ. June 18, 2005, Vol. 330, pp. 1416–1419.

Abstract online: http://bmj.bmjjournals.com