Safety of midwife-attended home births questioned

BALTIMORE, Maryland (Reuters Health) - The risk of newborns dying is higher when delivery is at home attended by a certified nurse midwife than when babies are born in hospitals with a certified nurse midwife in attendance, according to data released here at the meeting of the Pediatric Academic Societies.

"Currently, the only Western country with a substantial number of home births is the Netherlands, where 30 percent of births are in the home," Dr. Michael H. Malloy pointed out. "In the U.S., less than 1 percent of births are in the home, and the American College of Obstetrics and Gynecology 'does not support programs that advocate for, or individuals who provide, home births'."

Malloy, at the University of Texas Medical Branch in Galveston, compared outcomes in newborn babies by type of delivery attendant and by place of delivery in the U.S. over a recent 5-year period.

His analysis was limited to term babies delivered in the normal way. "I decided to restrict the analysis to this low-risk population because they would be the best candidates for home delivery," Malloy explained.

During the study period, there were almost 12 million such births. The great majority, 88.5 percent, were in hospitals with a physician attending. The next most common arrangement, 10.6 percent, was hospital delivery with a certified nurse midwife attending.

Far behind in popularity were hospital births with other nurse midwives (0.2 percent) births; home births with a certified nurse midwife on hand (0.1 percent); home delivery with other nurse midwives (0.4 percent); and birth-center delivery with a certified nurse midwife attending (0.2 percent).

While there were only 14 newborn deaths among babies delivered at home by a certified nurse midwife, this rate was more than two-fold higher than for hospital deliveries attended by a certified nurse midwife.

Furthermore, the rate was four-fold higher for home deliveries by other midwives.

Overall, the results demonstrate that the safest setting for a delivery is in hospital attended by a certified nurse midwife. Women who decide to deliver in the home "need to recognize the greater risk associated with that choice," Malloy said.

As for why in-hospital deliveries by certified nurse midwives had a lower risk of mortality in his study than in-hospital physician deliveries, Malloy said he assumes it's because physicians are delivering babies at higher risk.