Minimal Risk Found for Home Birth With a Licensed Midwife
In the US state of Washington, a planned home birth with a licensed midwife is just as safe as a birth at a licensed birth centre, according to researchers from the University of British Columbia and Bastyr University.
The research team of midwives, epidemiologists and obstetricians came to this conclusion after analysing outcomes of community births in Washington state between 2015 and 2020. The findings were reported in Obstetrics & Gynecology. A previous US study had shown that pregnancy outcomes with care provided by midwives had lower risks of caesarean and preterm birth than those with physician care.
The study analysed data from 10 609 home and birth centre births from midwives. Births met the professional association guidelines and were within regulatory standards. This included individuals with healthy pregnancies who were carrying to term with no history of caesarean delivery, and a foetus oriented for head-first birth.
“The birth setting had no association with increased risk for either parent or baby,” said lead author Elizabeth Nethery, PhD candidate at UBC. “Our findings show that when a state has systems to support the integration of community midwives into the healthcare system as Washington has done, birth centers and homes are both safe settings for birth.”
In the US, home birth is still controversial. The American College of Obstetricians and Gynecologists (ACOG) has stated that birth is safest at a hospital or an accredited birth centre, recommending against home birth because of countrywide studies that show higher rates of neonatal death among home births.
However, individual states have wide variations in licensing requirements, regulatory status and access to medications for midwives. These variations might contribute to differences in state level outcomes and reflected in national statistics.
Washington has worked to integrate midwifery into the healthcare system, with 3.5% of all births with midwives or at state-licensed birth centres. As a result, there is a low rate of 0.57 perinatal deaths per 1000 births, comparable to other countries where home birth is well-integrated into the health system and classed as low risk by ACOG.
“Washington provides a model for midwifery care and safe community birth that could be replicated throughout the U.S.,” said Nethery. “Currently, some U.S. states currently have no licensure available for community birth midwives at all, and this could be contributing to poorer birth outcomes in those states.”
Source: University of British Columbia
