Click here to view the CfM press release regarding the CPM2000 Study!

The long-awaited study of home births attended by CPMs during the year 2000 is finally here! 

“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ  2005;330:1416 (18 June).

The BMJ has published the paper on-line. Read it at http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

Published in the June 18 issue of the North America British Medical Journal, the study found that “planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births” according to the BMJ press release (see below).

Co-author Ken Johnson has stated that this is the largest study of its kind at this time.  The study is prospective (initial data submitted before the birth took place, so no births could be “left out”) and includes data from more than 5000 births in the U.S and Canada.  This study cannot be written off for being too small or not relevant to US populations and circumstances.

The BMJ also has a “rapid response” feature, where readers can post letters about articles (comments, responses, etc.). As the BMJ states:  “Think of Rapid Responses as electronic letters to the editor.”  On the BMJ home page www.bmj.com find “Interactions” in the menu list on the left, and choose “Rapid Responses” for more information. CfM is posting a rapid response shortly.

Would you like to see your local newspaper report about this study? The BMJ will have posted their press release to wire services, but this study may not be considered hot news by very many newspapers.  However, midwifery advocates all over the country can help get news attention on this study, especially if your state is working on midwifery legislation.  You may even be able to use this study as a way to bring a fledgling group and its work to positive public attention.  The best situation is when someone already has a relationship with a news reporter at your local newspaper (you have talked with them before, you have given them any news tips, etc.). Call up your contact and talk with them about this study and its relevance in your community, offer them the BMJ press release (see below) and additional information from author Betty-Anne Daviss (see below).  If you have a local birth network or birth-related advocacy group of any kind, make sure to let the reporter know how the study is relevant to your group and what it is doing. If you don’t already have a contact at your local paper, you could use this study as a reason to pick up the phone and begin a relationship.

When you read the study (it is not difficult to understand), you will find many points that can be made; here are a few to start with:

The study demonstrates unequivocally that for “low risk” mothers, home birth attended by a CPM results in outcomes comparable to low risk births in the hospital – ie CPM-attended planned home births are safe for mothers and babies.

Despite the fact that the midwives in the study included many who were not well-integrated into the health care system, mothers and babies that did need medical attention were appropriately identified and transported to hospitals and got the care they needed; otherwise, we would not see the good outcomes that are comparable to hospital birth outcomes.

Substantially fewer interventions were performed on mothers planning home births than on comparable mothers giving birth in hospitals, which suggests that many of those interventions are unnecessary. Such unnecessary interventions are costly and are associated with increased complications for mothers and babies.

Overall, the study shows that for healthy women, a planned home birth with a trained midwife (ie, a CPM), is a safe and reasonable choice for maternity care, supported by the evidence.  If maternity care is “scientific” women everywhere should have access to midwives and out-of-hospital birth.

Press Release from BMJ 

Planned home births in the United States are safe, say researchers.

Outcomes of planned home births with certified professional midwives: large prospective study in North America BMJ Volume 330, pp [to be added]

Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week's BMJ.

Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited.

Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America.

A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital.

 "Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions," say the authors. "This evidence supports the American Public Health Association's recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States."

Kenneth Johnson, Senior Epidemiologist, Surveillance and Risk Assessment
Division, Center for Chronic Disease Prevention and Control, Public Health
Agency of Canada, Ottawa, Canada  
Tel: 1 613 957 0339

To arrange an interview, please call Aggie Adamczyk: 1 613 941 8189 (Public Health Agency media contact)

Email: ken_lcdc_johnson@phac-aspc.gc.ca

Betty-Anne Daviss, Project Manager, FIGO Safe Motherhood/Newborn Initiative, Housed at The Society of Gynaecologists and Obstetricians of Canada, 780 Echo Drive, Ottowa, Canada
tel: 1 800 561 2416  OR  1 613 730 4192 Ext. 263

Email: badaviss@sogc.com