Home Birth Midwifery Service

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For centuries giving birth at home was the normal thing to do, but by the mid 1900's women began changing their birth setting by going to hospitals.

As our understanding of anatomy, modern medicine, the mechanics' of childbirth, and technology have significantly increased, more and more women are exploring the idea of a home birth with trained midwives.

As the desire for home birth grows, the number of studies and statistical data will continue to grow and give us a greater understanding of the risks and benefits. The information below will help increase your understanding as you move toward an informed decision.

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Homebirth ~ Is it Safe?

by Henci Goer, author of

The Thinking Woman's Guide to a Better Birth

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Outcomes of planned home birth: an integrative review.
J Midwifery Womens Health. 2007 Jul-Aug;52(4):323-33.

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Could home birth be for me?

Home birth might be an option for you if:

• You are having a healthy, low-risk pregnancy;
  
• You want to avoid episiotomy, cesarean section, epidural and other interventions;
  
• You want to be surrounded by family and friends;
  
• You want to be free to move around, change positions, take a shower, and eat or drink freely during labor;
  
• You want to enjoy the comforts of home and familiar surroundings.
  

Home birth is not for you if:

• You are diabetic;
  
• You have chronic high blood pressure, or pre-eclampsia;
  
• You experienced preterm labor in the past, or may be at risk for preterm labor now;
  
• Your partner does not fully support your decision to give birth at home.

All of life involves some risk, and this applies to giving birth and being born, wherever the birth takes place. At home there is always the possibility, no matter how small, of a tragic complication which could have been more effectively dealt with in hospital.

Parents choosing home birth will consider and come to terms with that risk, knowing that the risk of unnecessary interventions and the possibility of damage to the mother or baby, or both, may be far greater in hospital.

Hospital birth also increases the risk of the emotional/psychological disruption of being in an unfamiliar institution. It is well documented that other mammals, when disturbed in their nests in labor or moved to unfamiliar surroundings, have longer labors with more complications. Entering hospital undermines a woman's need to feel safe, secure and in familiar surroundings. This in turn interferes with her ability to relax and ultimately give herself up to the experience of birth.
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This 'letting go' - the ability to respond to a deep, instinctive knowledge of how to give birth to your baby - is an important part of letting the birth process unfold a smoothly and safely as possible. Deciding on a hospital birth, and thus handing over responsibility to the experts, may seem the easy option. The responsibility for choosing a home birth is obviously yours and on the surface of things may seem more complex. But the truth is, wherever you choose to give birth, it is still your baby, your body and your responsibility to balance the risks and benefits of the services offered.
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In the end, statistics alone cannot provide all the answers about where a baby should be born. They may give you food for thought, help guide you through the maze of conflicting view-points, help to free you from some popular misconceptions, and perhaps make home birth a real option for you. To arrive at a choice, which is right for you, it is important to go beyond statistical data and consider the things which really influence a good birth outcome for both mother and baby.

These include your own level of health, being well-nourished throughout your pregnancy, the practical as well as emotional and psychological support and care available to you during pregnancy, labor and beyond, the skills of your midwife and your own intuitive sense of where your baby should be born.

Many parents will anxiously sort through the pros and cons, but once they have

chosen home birth, they discover a growing excitement and confidence

in the rightness of their decision. Where to give birth is not a matter of

choosing between physical safety or going with your feelings.

The two are inextricably linked. Knowing this can help you

trust the wisdom of your instincts in choosing

the right place for your baby to be born.

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Certified Professional Midwife, Ina May Gaskin, mother of modern midwifery in the US, renowned author, and world-wide lecturer, has painstakingly gathered the following resources on home birth:

1. Abel S, Kearns, RA, 1991 "Birth Places: A Geographical Perspective on Planned Home Birth in New Zealand," Social Science & Medicine, Vol. 33, No. 7, 825-34.

2. Abernathy, Thomas J., Donna M. Lentjes, 1989  "Planned and Unplanned Home Births and Hospital Births in Calgary, Alberta, 1984-87", Public Health Reports, Vol. 104, No. 4, 373-77.

3. Acheson, Louise A., Stanley E. Harris and Stephen J. Zyzanski, 1980 "Patient Selection and Outcomes for Out-of-Hospital Births in One Family Practice", The Journal of Family Practice, Vol. 31, No. 2, 128-136.

4. Albers, Leah L., and Vern L. Katz, "Birth Setting for Low-Risk Pregnancies, an Analysis of the Current Literature", Journal of Nurse-Midwifery, Vol. 36, No. 4, July/August 1991, p. 215-220

5. Anderson, Rondi and Deborah Greener, 1991  "A Descriptive Analysis of Home Births Attended by CNMs in Two Nurse-Midwifery Services", Journal of Nurse-Midwifery, Vol 36, No. 2, 95-103.

6. Anderson, Rondi and Patricia Murphy, 1995  "Outcomes of 11,788 Planned Home Births Attended by Certified Nurse-Midwives: A Retrospective Descriptive Study," Journal of Nurse-Midwifery, Vol. 40, No. 6, 483-492.

7. Bortin, S, Alzuguray M, Dowd J, and Kalman J, 1994  "A Feminist Perspective on the Study of Home Birth: Application of a Midwifery Care Framework," Journal of Nurse-Midwifery, Vol. 39, No. 3, 142-9.

8. Boyer, Ernest L., 1990  "Midwifery in America: A Profession Reaffirmed", Journal of Nurse-Midwifery, Vol 35, No. 4, 214-19.

9. Burnett, Claude A., James A. Jones, Judith Rooks, et al, 1980  "Home Delivery and Neonatal Mortality in North Carolina", JAMA, Vol. 244, No. 24, 2741-45.

10. Cameron, J. C. et al, 1979  "Home Birth in Salt Lake County, Utah, American Journal of Public Health, Vol. 69, 716-717.

11. Campbell, & Rona, MacFarlane, 1987  Where to Be Born? The Debate and The Evidence. National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford, England.

12. Campbell, Rona, & MacFarlane, Alison, 1986   "Place of Delivery: A Review," British Journal of Obstetrics and Gynaecology, Vol. 83, 675-83.

13. Campbell, Rona et al, 1984   "Home births in England and Wales: Perinatal Mortality According to Intended Place of Delivery," British Medical Journal, Vol. 289: 721-24.

14. Chamberlain, M et al., 1991  "Consumer Interest in Alternatives to Physician-Centred Hospital Birth in Ottawa," Midwifery, Vol. 7, No. 2, 74-81.

15. Crotty, Maria, Andrew T. Ramsay, Rosemary Smart, and Annabelle Chan, "Planned Homebirths in South Australia 1976-1987", 1990  Medical Journal of Australia, Vol. 153, p. 664-71.

16. Cunningham JD, "Experiences of Australian Mothers Who Gave Birth Either at Home, at a Birth Centre, or in Hospital Labour Wards," 1993  Social Sciences & Medicine, Vol. 36, No. 4, 475-83.

17. Damstra-Wijmenga, "Home Confinement: the Positive Results in Holland," 1984  Journal of the Royal College of General Practitioners, Vol. 34, 425 -30 .

18. Buitendijk, S. 1994  "How Safe are Dutch Home Births? In: Abrahams E (ED) Successful Home Birth and Midwifery: the Dutch Model. Bergin, Garvey and Greenwood Press, Westport, Connecticut.

19. Declerq, Eugene, "Out-of-Hospital Births, US, 1978: Birthweight and Apgar Scores as Measures of Outcome," 1984  Public Health Rep Vol. 99, No. 1, 63-73.

20. Declerq, Eugene, 1993  "Where Babies Are Born and Who Attends Their Births: Findings from the Revised 1989 United States Standard Certificate of Live Birth," Obstetrics & Gynecology, Vol. 81, No. 6, 997-1004.

21. Devitt, Neal, 1977  "The Transition from Home to Hospital Birth, U.S.," Birth & Family Journal, Vol. 4, No. 1, 47-58.

22. Durand, A. Mark, "The Safety of Home Birth: The Farm Study," American Journal of Public Health, Vol. 82, No. 3, 450-3  1992.

23. Eskes, TK, 1992  "Home Deliveries in the Netherlands -- Perinatal Mortality and Morbidity. International Journal of Gynaecology & Obstetrics, Vol. 38, No. 3, 161-9.

24. Ford, Christine, Illife & Franklin, 1991  "Outcome of Planned Home Births in an Inner City Practice," British Medical Journal, Vol. 303, 1517-19.

25. Hafner-Eaton, C and Pearce, LK, 1995  "Birth Choices, the Law and Medicine: Balancing the Individual Freedoms and Protection of the Public's Health," Journal of Health Politics, Policy & Law, Vol. 19, No. 4, 813-35.

26. Hinds, M. Ward, Gershon H. Bergeisen and David T. Allen, 1985  "Neonatal Outcome in Planned Versus Unplanned Out-of-Hospital Births in Kentucky", JAMA, Vol. 253, No. 11, 1578-82.

27. Howe, K., 1988  "Home Births in South-west Australia," Medical Journal of Australia, Vol.149, 296-302.

28. Huygen, F. J., 1984  "Home Deliveries in Holland," Journal of the Royal College of General Practitioners, Vol. 34, 244-8.

29. Janssen, Patricia A., et al, 1994  "Licensed Midwife-Attended, Out-of-Hospital Births in Washington State: Are They Safe?" Birth, Vol. 21, No. 3, 141-8.

30. Klein, M. E., et al, 1983  "A Comparison of Low-Risk Pregnant Women Booked for Delivery in Two Systems of Care," British Journal of Obstetrics & Gynaecology, Vol. 90, 118-128.

31. Kenny P et al, 1993  "Satisfaction with Postnatal Care -- The Choice of Home or Hospital, Midwifery, Vol. 9, No. 3, 146-53.

32. Kleiverda, Gunilla, et al, 1990  "Place of Delivery in The Netherlands: Maternal Motives & Background Variables Related to Preferences for Home or Hospital Confinement," European Journal of Obstetrics & Gynecology & Reproductive Biology, Vol. 36, 1-9.

33. Kleiverda, Gunilla, et al, 1991  "Place of Delivery in The Netherlands: Actual Location of Confinement," European Journal of Obstetrics & Gynecology & Reproductive Biology, Vol. 39, 139-46.

34. Kloosterman, G. J., 1984  "The Dutch Experience of Domiciliary Confinements." In: Zander, L, Chamberlain, G. (eds). Pregnancy Care for the 1980s. The Royal Society of Medicine. London: Macmillan Press Ltd. 115-125.

35. Korte, Diana, "Infant Mortality: Lessons from Japan", Mothering, Winter 1992, 83 - 88.

36. Koehler, M. S. et al, 1984  "Outcomes of a Rural Sonoma County Home Birth Practice: 1976-1982. Birth, Vol. 11, No. 3, 165-169.

37. Lievaart, M. and DeJong, P., 1982  "Neonatal Morbidity in Deliveries Conducted by Midwives and Gynecologists: A Study of the System of Obstetric Care Prevailing in The Netherlands," American Journal of Obstetrics and Gynecology, Vol. 144, 376-386. For critique of this "flawed" study, see "Obstetricians' Flawed Study," P.E. Treffers MD, D. van Alten MD, The Practicing Midwife, Vol. 1, No. 19, 1983. See also Reference 61.

38. MacVicar J et al. 1993  "Simulated Home Delivery in Hospital: A Randomised Controlled Trial," British Journal of Obstetrics & Gynaecology, Vol. 100, No. 4, 316-23.

39. Mallison, Mary B., "Gate Crashers", American Journal of Nursing, February 1990, p. 7.

40. McClain, C,  1981  "Women's Choice of Home or Hospital Birth," Journal of Family Practice, Vol. 12, 1033-38.

41. McQuarrie, H., 1980  "Home Delivery Controversy," Journal of the American Medical Association, Vol. 243, No. 17, p. 1747.

42. Mehl, Lewis E., Gail H. Peterson, Michael Whitt and Warren E. Hawes, 1977  Outcomes of Elective Home Births: A Series of 1,146 Cases", The Journal of Reproductive Medicine, Vol. 19, No. 5, 281-290.

43. Murphy, J.F., Marjorie Dauncey, O.P. Gray, and I. Chalmers, 1984  "Planned and Unplanned Deliveries at Home: Implications of a Changing Ratio", British Medical Journal, Vol. 288, 1429-32.

44. Myers, S, et al, 1990  "Unlicensed Midwifery Practice in Washington state," American Journal of Public Health, Vol. 80, 726-8.

45. Philipps, E., 1984  "Planned and Unplanned Deliveries at Home," British Medical Journal, Vol. 1, 1996-7.

46. Rooks, Judith P., Norman L. Weatherby, et al, 1989  "Outcomes of Care in Birth Centers", New England Journal of Medicine, Vol. 321, p. 1804-11.

47. Rooks, Judith, "Low-Intervention Maternity Care," Journal of Family Practice, Vol. 31, No. 2, 125-7.

48. Sakala C, 1993  "Midwifery Care and Out-of-Hospital Birth Settings: How Do They Reduce Unnecessary Cesarean Section Births?" Social Science & Medicine, Vol. 37, No. 10, 1233-50.

49. Schrader, Catharina. The Memoirs (1693-1740) of the Frisian Midwife Catharina Schrader. 1987  Translated and annotated by Hilary Marland, with introductory essays by M.J. van Lieburg and G. J. Kloosterman. Rodopi, Amsterdam (available from Mrs. L. J. Brooke, 4595 Club Dr., NE, Atlanta, GA  30319

50. Schramm, Wayne F., Diane E. Barnes and Janice M. Bakewell, 1987  "Neonatal Mortality in Missouri Homebirths, 1978-84", AJPH, Vol. 77, No. 8, 930-35.

51. Shearer, J.M.L., 1985  "Five Year Prospective Risk of Booking for a Home Birth in Essex", British Medical Journal, Vol. 291, 1478-80.

52. Shy, KK, et al, 1980  "Out-of-Hospital Delivery in Washington State, 1975 to 1977, American Journal of Obstetrics & Gynecology, Vol. 137, 547-52.

53. Soderstrom, Bobbi, Paula J. Stewart, Christabel Kaitell, and Marie Chamberlain, 1990  "Interest in Alternative Birthplaces Among Women in Ottawa-Carleton", Canadian Medical Association Journal, Vol. 142, No. 9, 963-9.

54. Sullivan, Deborah A. and Ruth Beeman, 1983  "Four Years' Experience with Home Birth by Licensed Midwives in Arizona", AJPH, Vol. 73, No. 6, 641-5.

55. Tew, Marjorie, 1986  "Do Obstetric Intranatal Interventions Make Births Safer?", British Journal of Obstetrics and Gynaecology, Vol. 93, 659-74.

56. Tew, Marjorie, 1985  "Place of Birth and Perinatal Mortality," Journal of the Royal College of General Practitioners, Vol. 35, 390-4.

57. Tew, Marjorie, 1978  "The Case against Hospital Deliveries: the Statistical Evidence." In Kitzinger, S, Davies, JA (eds). The Place of Birth. Oxford University Press: pp. 55-65.

58. Tew, Marjorie, 1986  "Do Obstetric Intranatal Interventions Make Birth Safer?" British Journal of Obstetrics & Gynaecology, Vol. 93, No. 7, 659-74.

59. Treffers, Pieter E., Martine Eskes, Gunilla Kleiverda and Dik Van Alten, 1990  "Letter From Amsterdam: Home Births and Minimal Medical Interventions", JAMA, Vol. 264, No. 17, 2203-08.

60. Treffers, P. and Laan, R., 1986  "Perinatal Mortality and Hospitalization at Delivery in The Netherlands," British Journal of Obstetrics & Gynaecology, Vol. 93, 690-3.

61. Treffers, P, et al, 1983  "Condemnation of the Obstetric Care in The Netherlands?" American Journal of Obstetrics and Gynecology, Vol. 146, 871-2.

62. Tyson, Holliday, 1991  "Outcomes of 1001 Midwife-Attended Home Births in Toronto, 1983-1988, Birth, Vol. 18, No. 1, 14-9.

63. Van Alten, D., M. Eskes and P.E. Treffers, 1989  "Midwifery in the Netherlands. The Wormerveer Study; Selection Mode of Delivery, Perinatal Mortality and Infant Morbidity", British Journal of Obstetrics and Gynaecology, Vol. 96, 656-62.

64. Wagner, Marsden. Pursuing the Birth Machine: The Search for Appropriate Birth Technology. ACE Graphics, Sydney, 1994.

65. Wood, LAC. 1981  "Obstetric Retrospect," J R Coll Gen Pract, Vol. 31, 80-90.

66. Woodcock, Hazel C., Anne W. Read, Diane J. Moore, Fiona J. Stanley and Carol Bower, 1990  "Planned Homebirths in Western Australia 1981-1987: A Descriptive Study", The Medical Journal of Australia, Vol. 153, 672-8.

67. Wynn, Margaret, 1985  "Birthplace Survey," New Generation, Vol. 4, 1-9.

68. Zander, L. 1, 1981  "The Place of Confinement -- a Question of Statistics or Ethics?" Journal of Medical Ethics, Vol. 7, 125-7.

69. Having a Baby in Europe, Copenhagen, World Health Organization, 1985.

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71. Pearse W  1987  "Parturition: Places and Priorities," American Journal of Public Health, Vol. 77, 923-4.

72. Ackermann-Leibrich U et al  1994  "Comparing Home to Hospital Deliveries: Recruitment, Referrals, and Neonatal Outcome," Soz Praventivmed  Vol. 39, No. 1, 28.

73. British Medical Journal Editorial  1996  "Home Birth: Safe in Selected Women, and with Adequate Infrastructure and Support," British Medical Journal, Vol. 313, No. 7068. 1276-7.

74. Davies J, et al 1996  "Prospective Regional Study of Planned Home Birth," British Medical Journal, Vol. 313, No. 7068, 1302-6.

75. Northern Region Perinatal Mortality Survey Group  1996  "Collaborative Survey of Perinatal Loss in Planned and Unplanned Home Births," British Medical Journal, Vol. 313, No. 7068, 1306-9.

76. Weigers T et al  1996  "Outcome of Planned Home and Planned Hospital Births in Low Risk Pregnancies: Prospective Study in Midwifery Practices in the Netherlands," British Medical Journal, Vol. 313, No. 7068, 1309-13.

77. Ackermann-Leibrich U et al  1996  "Home versus Hospital Deliveries: Follow Up Study of Matched Pairs for Procedures and Outcome," British Medical Journal, Vol. 313, No. 7068, 1313-18.

78. Olesen O  1997  "A Meta-analysis of the Safety of Home Birth," Birth, March 1997.

79. Matsuoka, E  1995  "Is Hospital the Safest Place for Birth?" Gebären - Ethnomedizinische Perspektiven und neue Wege, Special Vol. 8, 293-304.

80. Declercq E  1994  "The Trials of Hanna Porn: The Campaign to Abolish Midwifery in Massachusetts," American Journal of Public Health, Vol. 84, No. 6, 1022-8.