Numerous studies have been done to study the safety and effectiveness of certified nurse-midwives, other midwives, home birth, and birth center birth. The evidence overwhelmingly shows that professional midwives provide safe care with excellent outcomes, and that birth can safely be accomplished outside of a hospital when proper precautions are taken.
Janssen PA, Saxell L, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal, 2009; 181 (6-7).
This matched cohort study compared the outcomes of planned home births attended by midwives to planned hospital births attended by midwives and physicians. The perinatal death rate was 0.35 per 1000 in the planned home birth group, 0.57 in the midwife attended planned hospital birth group, and 0.64 in the physician attended planned hospital birth group. Women in the planned home birth group were significantly less likely to experience obstetric interventions and adverse maternal outcomes than those in the midwife and physician attended planned hospital groups. Newborns in the home birth group were less likely than those in both hospital groups to require resuscitation at birth, oxygen therapy beyond 24 hours, and were less likely to have meconium aspiration. The authors state, "Our data indicate that screening for eligibility by registered midwives can safely support a policy of choice of birth setting."
. Fullerton JT, Navarro AM, Young SH. Outcomes of planned home birth: an integrative review. Journal of midwifery & women's health 2007 Jul-Aug;52(4):323-33.
This 2009 report provides information on Albertan women's reproductive health. Extensive information is provided on pregnancies and births, including outcomes, determinants, and care services. This report is recreated yearly, and contains information on the rate of home births (.8%) and midwife participation (1.4%) in births.
American Journal of Public Health (2003)
This San Diego study of 2957 low risk, low income women compared results of those receiving collaborative midwife/OB care to those receiving physician-only care. Women receiving collaborative care had fewer cesarean, vacuum, and forcep deliveries, fewer epidurals, fewer episiotomies, and fewer inductions. (10.7 vs 19.1% cesarean, 8.4 vs 18.1% assisted vaginal birth, 29.8 vs 68.6% epidurals, 13.1 vs 37.8% episiotomy, 8.4 vs 14.7% inductions). The groups had similar rates of preterm birth and low birth weight.
British Journal of Obstetrics & Gynecology (2009)
In a study of over 280,000 women in the Netherlands, 68% of women completed childbirth under the exclusive care of a midwife. 3.6% were referred on an urgency basis and 28.3% were referred without urgency. The main reasons for urgent referrals were fetal distress and postpartum hemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively.On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group. The authors conclude that risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives.
British Medical Journal (2005)
5,418 low-risk women who were planning to deliver at home with a Certified Professional Midwife were studied across North America to evaluate safety of planned homebirths.12.1% were transferred to hospital in labor, and intervention rates included 4.7% epidural, 2.1% episiotomy, 1.0% forceps, 0.6% vacuum, and 3.7% cesarean sections.Intervention rates were significantly lower than in low risk US women having hospital births.Neonatal mortality was 1.7 deaths per 1000 planned home births, which is similar to that of low risk hospital births in the United States.