The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Physician and Midwife Attended Home Births

The Journal of Nurse Midwifery, Vol. 42, No.2, March/April 1997.

"The effect of attending breech, twin, and post-dates pregnancies on home birth outcomes was assessed. The same form was used to collect data on a convenience sample of 4,361 home births attended by apprentice-trained midwives from 1970 to 1985. And 4,107 homebirth attend by family physicians from 1969 you 1981. Data sets compared to find 1,000 pairs of pregnant women, one from each group, who were matched for age, sex socioeconomic status, race, and medical risk. The perinatal mortality rate for births attended by family physicians was five per 1,000 (one fetal death before labor, two intrapartum fetal deaths, and two neonatal deaths). The difference was statistically significant: however the differences disappeared when cases involving post-dates, twin, or breech deliveries were eliminated from the sample. Although the data are more than a decade old, they support the premise that outcomes for low-risk home births are comparably good whether attended by physicians or midwives. However, the findings do raise questions about the safety of attending high-risk births at home."

". . . the high-risk population delivering at home was 3.1 times more likely to experience a mortality event than the low-risk population delivering at home"(95).

"Births involving these conditions are associated with higher perinatal mortality regardless of the place of birth" (96).

". . . midwives decide to attend higher-risk births at home for many reasons. Many, even most of these births can be achieved successfully at home. Being 'high risk' only means that the incidence of untoward outcomes in higher; it does not mean that every high-risk birth will have a poor outcome" (96).

"Until proven otherwise, however, practitioners should strive to avoid such deliveries at home given the findings of the study and despite the age of the data"(96).

And here is the final bit from Lewis Mehl-Madrona, MD, Ph.D. and Morgaine Mehl Madrona:

"Midwifery care and home births are appropriate choices for normal, low-risk births. However, services that may be needed at higher-risk births are not available as quickly or readily at home, and few midwives have enough experience with complicated births to acquire the necessary competency for their delivery at home. Having experience with a few high-risk births that turn out well can be deceiving and may lead to false confidence. Bad outcomes of high-risk home births hurt babies, parents, individual midwives, and the midwifery and home birth movements. The philosophy of home birth is based on normal births-birth that do not have a substantially increased risk of serious complications. Attending high-risk births at home undermines that philosophy" (97).

Okay folks-what do you think? You can save the flames for someone else. This is an open literature discussion and I have only repeated someone else's literature for your information.

Personally, I would be interested in hearing from homebirth midwives in other countries where homebirth is a more widespread then in the US. Do legally practicing midwives in other countries have the same stats for breech, twins and post dates?

I can accept that a legally practicing homebirth midwife should consider attending all breeches and twins in the hospital. Please notice that I said that the "midwife" should attend the birth; not turn the birth over to doctor. I have greater dilemma with the post dates pregnancy. My first pregnancy would have been considered post dates (truly three weeks), all went well. I have had a number of clients who were "post dates" but went on to have good pregnancies and more importantly good deliveries. The fluid was fine and the babies did well. As always it depends on the woman and her health. My feeling about post dates or any definite number determination or value on most protocol is that we leave out the variation for the human condition. We are all so very different. Each body, each woman. I have known pregnancies that I would have considered 'post dates' at 39 weeks simply because the women was unhealthy, the fluid decreasing, placenta not seeming to nourish anyone. My sense that it was time for that baby to be out. On the other hand, I have seen women that were 42-43.5 weeks (with no date's discrepancy). They were the pictures of health and their babies have done very well. Rather then look at the "number" don't we need to consider the overall picture of health? Perhaps it the term, "post dates" that seems unclear for me. If we could come up with a new term that would describe a time when health is the deciding factor rather then the NUMBER then I would accept that. This may not be legally sound, but my heart tells me it right.