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Are First-Time Mothers Who Plan Home Birth More Likely to Receive Evidence-Based Care? A Comparative Study of Home and Hospital Care Provided by the Same Midwives


Address correspondence to Suzanne Miller, RM, MMid, 255 Horokiwi Road, Horokiwi, Wellington 5016, New Zealand.



“Place of birth” studies have consistently shown reduced rates of obstetric intervention in low-technology birth settings, but the extent to which the place of birth per se has influenced the outcomes remains unclear. The objective of this study was to compare birth outcomes for nulliparous women giving birth at home or in hospital, within the practice of the same midwives.


An innovative survey was generated following a focus group discussion that compared midwifery practice in different settings. Two groups of matched, low-risk first-time mothers, one group who planned to give birth at home and the other in hospital, were compared with respect to birth outcomes and midwifery care, and in relation to evidenced-based care guidelines for low-risk women.


Survey data (response rate: 72%) revealed that women in the planned hospital birth group (= 116) used more pharmacological pain management techniques, experienced more obstetric interventions, had a greater rate of postpartum hemorrhage, and achieved spontaneous vaginal birth less often than those in the planned home birth group (= 109). All results were significant (p < 0.05).


Despite care by the same midwives, first-time mothers who chose to give birth at home were not only more likely to give birth with no intervention but were also more likely to receive evidence-based care. (BIRTH 39:2 June 2012)