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PHYSICIAN- AND MIDWIFE-ATTENDED HOME BIRTHS: Effects of Breech, Twin, and Post-Dates Outcome Data on Mortality Rates


  • Lewis Mehl-Madrona MD, PhD,

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    • Lewis Mehl-Madrona is Research Assistant Professor at the University of Arizona College of Medicine Native American Research and Training Center. He has published many articles on home birth outcomes in the United States. His research on Native American studies is described in his book, Coyote Medicine. He is board certified in family practice and geriatrics and board eligible in psychiatry and emergency medicine, and has attended home births as part of his practice in California, Wisconsin, and Vermont from 1973 until 1996.

  • Morgaine Mehl Madrona

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    • Morgaine Mehl Madrona is a midwife who has practiced in the Catskill Mountain area of Oneonta, New York and in the greater Burlington, Vermont region. She is currently writing a book about the future of midwifery and normal childbirth in the United States. She has assisted in promoting midwifery legislation in Vermont and has organized political programs that advocate for the legalization of one level of professional midwife who is able to practice in any setting, rather than the pervasive two-tiered system of certified nurse-midwives practicing primarily in the hospital and several other types of midwives all practicing in the home.

Lewis Mehl-Madrona, MD, PhD, Native American Research and Training Center, University of Arizona College of Medicine, 1642 E. Helen St., Tucson, AZ 85719.


The effect of attending breech, twin, and post-date 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 home births attended by family physicians from 1969 to 1981. Data sets were 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 the midwife-attended births was 14 per 1,000 (three fetal deaths before labor, six intrapartum fetal deaths, and five neonatal deaths). 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.