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Comparative Study
. 2015 Mar;212(3):350.e1-6.
doi: 10.1016/j.ajog.2014.10.021. Epub 2014 Oct 15.

Perinatal risks of planned home births in the United States

Amos Grünebaum  1 , Laurence B McCullough  2 , Robert L Brent  3 , Birgit Arabin  4 , Malcolm I Levene  5 , Frank A Chervenak  6
Affiliations
Comparative Study

Perinatal risks of planned home births in the United States

Amos Grünebaum et al. Am J Obstet Gynecol. 2015 Mar.

Abstract

Objective: We analyzed the perinatal risks of midwife-attended planned home births in the United States from 2010 through 2012 and compared them with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) for planned home births.

Study design: Data from the US Centers for Disease Control and Prevention's National Center for Health Statistics birth certificate data files from 2010 through 2012 were utilized to analyze the frequency of certain perinatal risk factors that were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives. Home birth deliveries attended by others were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP.

Results: Midwife-attended planned home births in the United States had the following risk factors: breech presentation, 0.74% (odds ratio [OR], 3.19; 95% confidence interval [CI], 2.87-3.56); prior cesarean delivery, 4.4% (OR, 2.08; 95% CI, 2.0-2.17); twins, 0.64% (OR, 2.06; 95% CI, 1.84-2.31); and gestational age 41 weeks or longer, 28.19% (OR, 1.71; 95% CI, 1.68-1.74). All 4 perinatal risk factors were significantly higher among midwife-attended planned home births when compared with certified nurse midwives-attended hospital births, and 3 of 4 perinatal risk factors were significantly higher in planned home births attended by non-American Midwifery Certification Board (AMCB)-certified midwives (other midwives) when compared with home births attended by certified nurse midwives. Among midwife-attended planned home births, 65.7% of midwives did not meet the ACOG and AAP recommendations for certification by the American Midwifery Certification Board.

Conclusion: At least 30% of midwife-attended planned home births are not low risk and not within clinical criteria set by ACOG and AAP, and 65.7% of planned home births in the United States are attended by non-AMCB certified midwives, even though both AAP and ACOG state that only AMCB-certified midwives should attend home births.

Keywords: home birth; midwives; perinatal risks.

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Comment in

  • Perinatal risks of planned home births in the United States.
    Snyder A. Snyder A. Am J Obstet Gynecol. 2016 Feb;214(2):295. doi: 10.1016/j.ajog.2015.09.087. Epub 2015 Nov 12. Am J Obstet Gynecol. 2016. PMID: 26432467 No abstract available.
  • Reply.
    Grünebaum A, McCullough LB, Chervenak FA. Grünebaum A, et al. Am J Obstet Gynecol. 2016 Feb;214(2):295. doi: 10.1016/j.ajog.2015.09.090. Epub 2015 Oct 9. Am J Obstet Gynecol. 2016. PMID: 26450409 No abstract available.