Perinatal risks of planned home births in the United States

Amos Grünebaum; Laurence B McCullough; Robert L Brent; Birgit Arabin; Malcolm I Levene; Frank A Chervenak

doi:10.1016/j.ajog.2014.10.021

Perinatal risks of planned home births in the United States

Am J Obstet Gynecol. 2015 Mar;212(3):350.e1-6. doi: 10.1016/j.ajog.2014.10.021. Epub 2014 Oct 15.

Authors

Amos Grünebaum¹, Laurence B McCullough², Robert L Brent³, Birgit Arabin⁴, Malcolm I Levene⁵, Frank A Chervenak⁶

Affiliations

¹ Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY. Electronic address: amg2002@med.cornell.edu.
² Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
³ Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY; Departments of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, and Alfred I. DuPont Hospital for Children, Wilmington, DE.
⁴ Center for Mother and Child, Philipps University, Marburg, and Clara Angela Foundation, Berlin, Germany.
⁵ Division of Pediatrics and Child Health, University of Leeds, Leeds, England, UK.
⁶ Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.

PMID: 25446661
DOI: 10.1016/j.ajog.2014.10.021

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.

Publication types

Comparative Study
Evaluation Study

MeSH terms

Certification
Databases, Factual
Delivery, Obstetric
Female
Home Childbirth / standards
Home Childbirth / statistics & numerical data*
Humans
Midwifery / standards
Midwifery / statistics & numerical data*
Nurse Midwives / standards
Nurse Midwives / statistics & numerical data
Pregnancy
Pregnancy, High-Risk*
Risk Factors
United States