SAFETY, EQUIPMENT & RESEARCH

Safety and research are important to ensure the best quality care, especially in home birth settings. Midwives are trained medical professionals who are specialists in normal pregnancy, birth, and newborn care. We provide comprehensive prenatal care including referral for laboratory tests, ultrasound and genetic screening and are trained to screen for and manage common complications of pregnancy and childbirth. When necessary, we work collaboratively and refer to alternative health care modalities as well as obstetricians, pediatricians and neonatologists. Our collaborative relationship with hospital-based providers is one of the components of home birth safety, since rapid transfer and smooth arrival is optimal for safety.

SAFETY & EQUIPMENT

Midwives are the only health-care providers trained and equipped to provide all the necessary care that you and your baby will need at your home birth. The equipment midwives bring along with them to home births is equivalent to what would be found in a community hospital, including oxygen, IV fluids, medications to stop bleeding and sterile instruments.

Midwives carefully monitor the baby throughout labor, using intermittent auscultation by doppler, (as recommended for low-risk labors by many midwifery and obstetric organizations in the ‘first’ world). Mother’s vital signs, urinalysis, progress, etc are also monitored regularly. We are trained in and re-certified regularly in emergency newborn resuscitation (NRP) and adult CPR.

Midwives continually evaluate and assess the mother, baby and the overall situation to confirm all is normal and do not wait for a crisis to consider moving from home to hospital. Research shows transfer to hospital is far more common for an exhausted mother and a slow labor rather than an emergency. During a home birth, if we determine that it would be best for you to move to a hospital, I will accompany you to hospital and continue to care for you in a supportive role. If there is a need to transfer in an emergency, I will keep you and/or your baby medically stable, arrange the transfer and stay with you until your baby is born and/or until the situation has been resolved.

SAFETY & RESEARCH

The comparative safety of different birth settings has been widely debated. Global research shows that home birth is a safe option for healthy women experiencing low-risk pregnancies who have chosen skilled/trained care providers. Research demonstrates that home birth is at least as safe as hospital birth, in large part because of the skills and education midwives bring with them, but also because of interventions routinely done in hospital that home birth midwives don’t offer. These interventions often cause an increased risk of postpartum hemorrhage, instrumental deliveries (forceps and vaccuum), severe perineal trauma (episiotomies) and a significantly increased risk of cesarean section.

Significant and excellent research published in July 2018, gathered 28 studies and synthesized the results, confirming that home birth is a safe option for low-risk pregnancies. (See link below.) Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or hemorrhage at a lower rate in planned home births than in obstetric units as well.

High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies…

Outcomes of planned home birth…

Outcomes associated with planned place of birth…

The safety of home birth…

HOME BIRTH: An annotated guide to the literature…

U.S. Research

In a comprehensive US study of almost 17,000 American women planning home birth with midwives between 2004-2009, the results are excellent. Low-risk women in this study experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes. The majority of  transfers were for failure to progress. The rate of spontaneous vaginal birth was 93.6%, 87% of VBACs, also known as Vaginal Birth After Cesarean, were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. Excluding lethal anomalies, the neonatal mortality rates were 0.35-1.30.

Encouragingly, in terms of the relative risks of home birth, a recent study based on the largest available U.S. dataset on physiologic birth (more than 40,000 cases of birth planned in the community setting), derived from medical records, the gold standard of medical research, showed some groups – those with advanced maternal age (>35 years of age) or high BMI (>25 kg/m2) – had only a slightly elevated risk (as compared to the very low-risk control group), resulting in a low absolute risk of serious complications.
Even ACOG (American College of Obstetricians and Gynecologists) states: “recent studies have found that when compared with planned hospital births, planned home births are associated with fewer maternal interventions, including labor induction or augmentation, regional analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery. Planned home births also are associated with fewer vaginal, perineal, and third-degree or fourth-degree lacerations and less maternal infections”. 
Outcomes of Care for 16924 Planned Home Births in the United States …
Home birth safety, MANA…
Outcomes of planned home births with certified professional midwives…

Contact Nancy Greenwood LM CPM