OUTCOMES OF 11,788 PLANNED HOME BIRTHS ATTENDED BY CERTIFIED NURSE-MIDWIVES

A Retrospective Descriptive Study

Authors

  • Rondi E. Anderson CNM, MS,

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    • Rondi Anderson, CNM, MS, was the principle investigator for this study. She is a nurse-midwife in a busy home birth practice in Lancaster County, Pennsylvania serving a largely Old Order Amish population. Her practice is a clinical site for nursing and midwifery students and family practice residents. She is a membrane of the ACNM home birth committee and MANA. She received her master's degree and nurse-midwifery education from the University of Utah, graduating in 1989, and a BSN from Michigan State University in 1985. Prior to her nursing education she practiced midwifery for 10 years in a home birth practice in Michigan.

  • Patricia Aikins Murphy CNM, DRPH

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    • Patricia Aikins Murphy is an assistant professor of nursing in the Columbia University Nurse-Midwifery Education Program. She received her MS in nurse-midwifery from that program in 1979, and her DrPH in epidemiology from the Columbia University School of Public Health in 1993. She is the principal investigator of an on-going prospective study of the process and outcomes of home births attended by certified nurse-midwives.


241 E. Orange, Lancaster, PA 17602.

ABSTRACT

This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNMs) from 1987 to 1991. A retrospective survey was used to obtain information about the outcomes of intended home birth, including hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery home birth practices). It is estimated that 60–70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000, including known third-trimester fetal demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality rate for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartum transfer rate for those intending home birth at the onset of labor was 8%. Most responding nurse-midwives used standard risk-assessment criteria, only delivered low-risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women.

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