Home birth care is available in Minnesota for healthy women who want to give birth in their own homes. Two common questions about home birth are, "Is it safe?" and "What about the mess?" The answer to the second question is that the midwife tidies up after the birth. The answer to the first question is answered by a study from the Netherlands and a new study from Canada. Home birth is as safe as hospital birth. Marsden Wagner, former busts three myths about out-of-hospital birth.

The studies on home birth that compare low risk women planning birth at home to low risk women giving birth in the hospital show that home birth is as safe as hospital birth. Having a trained and experienced midwife at the birth makes the birth safer than planned birth without a midwife. Of course, planning the birth makes outcomes safer than a fast birth that, by surprise, happens at home without preparation.

Canadian researchers looked at almost 13,000 births and found homebirth with midwives to be the same, or a little safer, than hospital birth with either midwives or physicians. See the US Today article Study: Homebirth with Midwife as Safe as Hospital Birth. See the Canadian Medical Association Journal abstract or download the research study,

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

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.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.

The British Broadcasting Company announced 

Home births 'as safe as hospital'

New research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.

In 2005, the same finding comes from the statistics of Certified Professional Midwife (CPM) attended births in North America

Outcomes of planned home births with certified professional midwives: large prospective study Johnson and Daviss BMJ.2005; 330: 1416

(You can read the full article, but you must register at the British Medical Journal.)

The North American study followed 5418 women expecting to deliver in the year 2000 with CPM midwives at home when labor began.

The study looked at death in labor and the first 28 days after birth, perinatal transfer to hospital care, medical intervention during labor, breast feeding, and maternal satisfaction.

"Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States."

A third study from Denmark in 1997 found similar safety for homebirth:

Meta-analysis of the safety of home birth.

"This study examined the safety of planned home birth backed up by a modern hospital system compared with planned hospital birth in the Western world... 24,092 selected and primarily low-risk pregnant women were analyzed to measure mortality and morbidity, including Apgar scores, maternal lacerations, and intervention rates. Confounding was controlled through restriction, matching, or in the statistical analysis. RESULTS: Perinatal mortality was not significantly different. The principal difference in the outcome was a lower frequency of low Apgar scores and severe lacerations in the home birth group. Fewer medical interventions occurred in the home birth group: induction, augmentation, episiotomy, operative vaginal birth, and cesarean section. No maternal deaths occurred in the studies. 

CONCLUSION: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions."

What is safety? Is safety only a living mother and baby? Is it no complications or is it the quick and appropriate handling of common birth complications?

Does safety include an emotional aspect? For instance, does a woman's satisfaction with her birth experience increase the likelihood of her healthy adjustment to parenting?

Marsden Wagner confronts three myths about birth outside of the hospital. Here is a brief portion from Birth International website, with Australian spellings. Enjoy.

Fish can't see water The need to humanize birth in Australia

Also by Marsden Wagner Book: Pursuing the Birth Machine Article : The Active Management of Labour Article : Marsden Wagner: Ultrasound

by Marsden Wagner (MD, MSPH)
		Marsden began his career in public health as a neonatologist and epidemiologist, firstly in California then Denmark. He retired from a distinguished career as head of Maternal and Child Health for the European Office of the World Health Organisation (WHO), he now acts as a consultant for WHO in the emerging countries of central and eastern Europe. He chaired the three consensus conferences convened by WHO on appropriate technology around the time of birth and is in demand as an international speaker for his forthright support of midwifery and midwives.

"Many clinicians and their organizations continue to believe in the dangers of planned out-of-hospital birth, either in a center birth or at home, rejecting the overwhelming evidence that planned out-of-hospital birth for low risk women is safe. The clinician's response to this evidence is "But what if there is an out-of-hospital birth and something happens?" Since most clinicians have never attended an out-of-hospital birth, their 'what if' question contains several false assumptions. The first assumption is that in birth things happen fast. In fact, with very few exceptions, things happen slowly during labour and birth and a true emergency when seconds count is extremely rare and, as we will see below, often in these cases the midwife in the birth center or home can take care of the emergency.

"The second false assumption, that when trouble develops there is nothing an out-of-hospital midwife can do, can only be made by someone who has never observed midwives at out-of-hospital births. A trained midwife can anticipate trouble and usually prevent it from happening in the first place as she is providing constant one-on-one care to the birthing woman, unlike in the hospital where usually nurses or midwives can only look in occasionally on the several women in labour for which they are responsible. If trouble does develop, with few exceptions the out-of-hospital midwife can do everything which can be done in the hospital including giving oxygen, etc. For example, when a baby's head comes out but the shoulders get stuck, there is nothing which can be done in the hospital except certain maneuvers of the woman and baby, all of which can be done just as well by the out-of-hospital midwife. The most recent successful maneuver for suchshoulder dystocia reported in the medical literature is named after the home birth midwife who first described it (Gaskin maneuver).^[10]

"The third false assumption is there can be faster action in the hospital. The truth is that in private care the woman's doctor often is not even in the hospital most of the time during her labour and must be called in by the nurse when trouble develops. The doctor 'transport time' is as much as the 'transport time' of a woman having a birth center or home birth. Even when a caesarian section is indicated, it takes on average 20 minutes for the hospital to set up for surgery, locate the anesthesiologist, etc. and during this 20 minutes either the doctor or the birth center or home birthing woman are in transit to the hospital. This is why it is important for a good collaborative relationship between the out-of-hospital midwife and the hospital so when the midwife calls the hospital to inform them of the transport, the hospital will waste no time in making arrangements for the incoming birthing woman. These are the reasons there are no data whatsoever to support the single case, anecdotal 'what if' scenario used by some doctors to scare the public and politicians about out-of-hospital birth."

 From http://www.birthinternational.com/articles/wagner03.html

Back to Minnesota...

Midwives are almost universally the care providers for home birth, but not all midwives attend homebirths.

Midwives who give care for birthing women and newborns in the home have gained a special perspective and training for normal birth. Knowledge about home birth is unique to midwives trained through apprenticeship by a more experienced homebirth midwife. Midwives trained in institutions, such as universities and hospitals, have occasionally left those settings to attend home births. A very few physicians attend homebirths; none in Minnesota at this time, to my knowledge. A few naturopaths attend homebirths in Minnesota.

Only one out-state Minnesota midwife practices both in the hospital and at home. Other midwives here care for families in one setting or the other, but not both.

Home birth midwives often work cooperatively with doctors for the sake of best care. Working collaboratively, parents who choose homebirth care can be referred to a physician for monitoring, assessment and medical treatment should the need arise in pregnancy, during or after the birth or to have prenatal care by both a physician and the homebirth midwife, should the parents need or desire the care. If during a homebirth, the woman or baby needs the kind of care that is available in the hospital, their midwife will accompany them to the hospital and transfer care to someone with hospital privileges such as a doctor or midwife.

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