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momma6_2angels October 23rd, 2006 10:19 AM

Midwife Attended Births at Home are Statistically Safe

The following citations are from various sources and indicate research outcomes pointing to the
safety of birth at home under the care of midwives.

1 . "Every study that has compared midwives and obstetricians has found better outcomes
for midwives for same-risk patients. In some studies, midwives actually served higher risk
populations than the physicians and still obtained lower mortalities and morbidities. The
superiority and safety of midwifery for most women no longer needs to be proven.
It has been well established."
(Madrona, Lewis & Morgaine, The Future of Midwifery in the United States,
NAPSAC News, Fall-Winter, 1993, p.30)

2."In the U.S. the national infant mortality rate was 8.9 deaths per 1,000 live births [in 1991]. The worst
state was Delaware at 11.8, with the District of Columbia even worse at 21.0. The best state was Vermont,
with only 5.8. Vermont also has one of the highest rates of home birth in the country as well
as a larger portion of midwife-attended births than most states. "
(Stewart, David, International Infant Mortality Rates--U.S. in 22nd
Place, NAPSAC News, Fall- Winter, 1993, p.36)

3. This study compares matched populations of homebirths attended by non-nurse
midwives with hospital births attended by physicians. It concludes that the midwife
sample has significantly better maternal and neonatal outcomes and attributes this fact to
physicians high rate of intervention.
Evaluation of Outcomes on Non-Nurse Midwives.Matched Comparisions with Physicians.
By Lewis Mehl, M.D. et al. Women and Health, Vol. 5, 1980.

4. The Texas Department of Health's own statistics shows that midwives in Texas have a
lower infant mortality rate than physicians.
Texas Midwifery Program, Six Year Report,1983- 1989, Berstein & Bryant, Appendix Vlllf.

5. "Mehl and his colleagues (1975, 1977) reviewed the medical records of 1,146 home
births attended by five home delivery services in northern California between 1970 and
1975. These investigators provided detailed descriptions of demography (e.g., urban or
rural), attendants, population served, process of care, outcomes, and complications. The
incidence of various events among home births was compared to the incidence of similar
events in the birth population of the state of California or as reported in the literature. No
maternal deaths were noted, and the perinatal mortality rate of 9.5 per 1000 births was
lower than the California average."
(Research Issues in the Assessment of Birth Settings,
Institute of Medicine, National Academy Press, Washington, 1982, p. 76)

6. From the same source (Figure 1, p. 175): In the state of Oregon from 1975-1979, there
were approximately 3-4 neonatal deaths per 1000 births in homebirths attended by
midwives, as opposed to approximately 9-10 deaths per 1000 births for all residents. The
same figure indicates approximately 5 infant deaths per 1000 births in homebirths
attended by midwives, as opposed to approximately 12 deaths per 1000 births for all
(Research Issues in the Assessment of Birth Settings, Institute of Medicine,
National Academy Press, Washington, 1982, p. 175)

7. "Of the 3,189 midwife-assisted deliveries studied, episiotomies were done on 5 percent
of the women, the Caesarean section rate varied from 2.2 percent to 8.1 percent, and
perinatal mortality (the number of babies who die during or shortly after birth) averaged
5.2 per 1,000. Compare these numbers to those for New Mexico obstetricians and
physicians during the same period: nearly routine use of episiotomies in many hospitals, a
Caesarean rate that varied from 15 percent to 25 percent,and a perinatal mortality rate of
11.3 per 1,000. Looking at these numbers, Rebecca Watson, the maternal-health program
manager at the New Mexico Department of Health commented, 'I sometimes wonder why
[we bother compiling statistics on midwives], since their statistics are so much better than
everyone else's. "
(Sharon Bloyd- Peshkin, Midwifery: Off to a Good Start, p. 69, Vegetarian Times, December 1992)

8. Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per
1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries.
(The Place of Birth, Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)

9. "In The five European countries with the lowest infant mortality rates, midwives
preside at more than 70 percent of all births. More than half of all Dutch babies are born
at home with midwives in attendance, and Holland's maternal and infant mortality rates
are far lower than in the United States..."
("Midwives Still Hassled by Medical Establishment," Caroline Hall Otis,
Utne Reader, Nov./Dec. 1990, pp. 32-34)

10. "Mothering Magazine has calculated that using midwifery care for 75% of the births
in the U.S. would save an estimated $8.5 billion per year."
(Madrona, Lewis & Morgaine, The Future of Midwifery in the United States,
NAPSAC News, Fall-Winter, 1993, p. 15)

Birth is Not an Illness!

The resource for this article comes from the Texas Midwives website.

16 Recommendations from the World Health Organization

These 16 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care:
that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care:
and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

The whole community should be informed about the various procedures in birth care, to enable each woman to choose
the type of birth care she prefers.

The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy and birth and following birth should be the duty of this profession.

Information about birth practices in hospitals (rates of cesarean sections, etc.) should be given to the public served by the hospitals. There is no justification in any specific geographic region to have more than 10-15% cesarean section births (the current US c-section rate is estimated to be about 23%).

There is no evidence that a cesarean section is required after a previous transverse low segment cesarean section birth. Vaginal deliveries after a cesarean should normally be encouraged wherever emergency surgical capacity is available.

There is no evidence that routine electronic fetal monitoring during labor has a positive effect on the outcome of pregnancy.

There is no indication for pubic shaving or a pre-delivery enema.

Pregnant women should not be put in a lithotomy (flat on the back) position during labor or delivery.
They should be encouraged to walk during labor and each woman must freely decide which position to adopt during delivery.

The systematic use of episiotomy (incision to enlarge the vaginal opening) is not justified.

Birth should not be induced (started artificially) for convenience and the induction of labor should be reserved for specific medical indications. No geographic region should have rates of induced labor over 10%.

During delivery, the routine administration of analgesic or anesthetic drugs, that are not specifically required to correct or prevent a complication in delivery, should be avoided.

Artificial early rupture of the membranes, as a routine process, is not scientifically justified.

The healthy newborn must remain with the mother whenever both their conditions permit it.
No process of observation of the healthy newborn justifies a separation from the mother.

The immediate beginning of breastfeeding should be promoted, even before the mother leaves the delivery room.

Obstetric care services that have critical attitudes towards technology and that have adopted
an attitude of respect for the emotional, psychological and social aspects of birth should be identified. Such services should be encouraged and the processes that have led them to their position must be studied so that they can be used as models to foster similar attitudes in other centers and to influence obstetrical views nationwide.

Governments should consider developing regulations to permit the use of new birth technology only after adequate evaluation.

Compiled from Care in Normal Birth: report of a technical working group 1997 - WHO/FRH/MSM/96.24

Lash October 23rd, 2006 10:28 AM

I heart the texas midwives site, so glad i have that resource !

MrsPil October 23rd, 2006 10:38 AM

Excellent information!

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