Having a baby at home is a safe and satisfying option for many women. Numerous studies have found that home birth is a reasonable alternative to hospital birth when women are appropriately screened for risks and attended by trained midwives. (See citations below.) In addition, planned home births involve fewer costly procedures and result in fewer Cesarean sections.

A recently published study of Washington State home births has re-kindled a long-standing controversy over the safety of home birth by suggesting that planned home births are associated with an increased risk of adverse outcomes. An early release of the study results led to media reports containing misleading statements and headlines like "Home Births Linked to More Infant Deaths."

Childbearing women and health policy makers should be made aware that the study contains numerous flaws and limitations. It is critical to distinguish between planned and unplanned home births when examining birth outcomes. The researchers, by their own admission, could not satisfactorily address this problem using the available birth certificate data and their findings are therefore unreliable. This study alone should not be used to make decisions that could restrict women's choice of birthplace or access to birth attendants with expertise in home birth.

Midwives are the primary attendants at home births in Washington State. Unfortunately, the research team did not include midwives or other health professionals with expertise in home birth who could have made important contributions to the study design and analysis. Members of the Midwives Association of Washington State are committed to providing safe, evidence-based care and are eager to assist in a re-analysis of the data in order to obtain accurate information that could lead to improved services.

The Midwives Association of Washington State, founded in 1983, represents midwives who are licensed to provide complete maternity care to healthy women planning home, birth center or hospital births. Midwives attend thousands of births each year in the state, including the one thousand-plus births that occur at home. For more information about midwives in Washington State see www.washingtonmidwives.org. To learn about midwives in other states see www.mana.org and to find out about the midwifery model of care see www.midwivesmodelofcare.org.

CITATIONS

Janssen, PA, et al. (2002) Outcomes of Planned Home Births versus Planned Hospital Births after Regulation of Midwifery in British Columbia.  Canadian Medical Association Journal. 166:315-23.

Olsen, O. (March 1997) Meta-analysis of the Safety of Home Birth. Birth. 24(1):4-13.

Cawthon, L. (July 1996) Planned Home Births: Outcomes among Medicaid Women in Washington State.  Office of Research and Data Analysis, Washington State Department of Social and Health Services. Report number 7.93.

Ackermann-Liebrich U, et al. (1996) Home versus Hospital Deliveries: Follow-up Study of Matched Pairs for Procedures and Outcome.  British Medical Journal. 313:1313-8.

Declercq, ER, Paine, LL and MR Winter. (November/December 1995) Home Birth in the United States, 1989-1992: A Longitudinal Description Report of National Birth Certificate Data. Journal of Nurse-Midwifery. 49(6):474-82.

Anderson, RE and PA Murphy. (1995) Outcomes of 11,788 Planned Home Births Attended by Certified Nurse-Midwives. Journal of Nurse-Midwifery. 40:483-92.

Janssen, PA, et al. (September 1994) Licensed Midwife-Attended, Out-of-Hospital Births in Washington State: Are They Safe? Birth. 21(3):141-8.

Anderson, R. and DA. Anderson. (January/February 1999) The Cost-Effectiveness of Home Birth. Journal of Nurse-Midwifery. 44(1):30-35.

Pang, J. et al. (August 2002) Outcomes of Planned Home Births in Washington State: 1989-1996. Obstetrics and Gynecology. 100(2):253-259.

Stenson, J. (May 2002) Home Births Linked to More Infant Deaths. www.reutershealth.com

Myers-Ciecko, JA. (July/August 1999) Evolution and Current Status of Direct-entry Midwifery Education, Regulation and Practice in the United States with Examples from Washington State. Journal of Nurse-Midwifery. 44(4):384-93.

Schlenzka, PF. (August 1999) Safety of Alternative Approaches to Childbirth. Unpublished Dissertation. Stanford University.