The largest prospective study of planned home birth with a direct-entry midwife shows that homebirth is as safe as hospital birth for low-risk women, yet carries a much lower rate of medical interventions, including Cesarean section.

“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), is published online at <http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom>.

Planning a home birth attended by a Certified Professional Midwife offers as safe an outcome for low-risk mothers and babies as does hospital birth. This study is the largest yet of its kind. The researchers used prospective data on more than 5,400 planned home births in North America attended by Certified Professional Midwives during the year 2000.

Canadian researchers Johnson and Daviss studied more than 5,400 low-risk pregnant women planning to birth at home in the United States and Canada in 2000. The researchers analyzed outcomes and medical interventions for planned home births, including transports to hospital care, and compared these results to the outcomes of 3,360,868 low-risk hospital births. According to the British Medical Journal press release, they found:
  • Eighty-eight percent of the women birthed at home, with 12 percent transferring to hospital.

  • Planned home birth carried a rate of 1.7 infant deaths per 1,000 births, a rate "consistent with most North American studies of intended births out of hospital and low-risk hospital births."

  • There were no maternal deaths.

  • Medical intervention rates of planned home births were dramatically lower than of planned hospital births, including: episiotomy rate of 2.1 percent (33.0 percent in hospital), Cesarean section rate of 3.7 percent (19.0 percent in hospital), forceps rate of 1.0 percent (2.2 percent in hospital), induction rate of 9.6 percent (21 percent in hospital), and electronic fetal monitoring rate of 9.6 percent (84.3 percent in hospital).

  • Ninety-seven percent of the more than 500 participants who were randomly contacted to validate birth outcomes reported that they were extremely or very satisfied with the care they received.


  • The Midwives Alliance of North America celebrates the publication of this groundbreaking study demonstrating the safety and satisfaction that are hallmarks of the care provided to North American women birthing at home with midwives. This study is the largest of its kind to date; it eliminates confounding factors by distinguishing between planned and unplanned birthplace; and because of the study's prospective nature, it is able to assure accounting for all outcomes. The authors' finding that Certified Professional Midwives "achieve good outcomes among low risk women without routine use of expensive hospital interventions" challenges the unnecessary proliferation of many interventions performed routinely on women and babies in low-risk hospital births. This study:
    • Provides irrefutable evidence in support of the American Public Health Association's resolution (2001) to increase access to out-of-hospital births attended by direct-entry midwives.

    • Supports the World Health Organization 1996 statement that “midwives are the most appropriate primary healthcare provider to be assigned to the care of normal birth.”

    • Supports the Coalition for Improving Maternity Services (CIMS) 1996 statement that, “midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes.”

    • Supports what midwives have always asserted: that planned home birth with a trained midwife is a safe, high-quality, satisfying, cost-effective choice for healthy women and their babies that results in superior outcomes. The Midwives Alliance of North American (MANA) recommends making midwifery care the gold standard in maternity care in North America.


    For more information about midwifery in North America, contact the Midwives Alliance of North America, Abby J. Kinne, 1st Vice President, (888) 317-8841, <1stvp@mana.org>.