Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (9)

Homebirth Risks: Babies Three Times More Likely To Die

By Amy Tuteur, MD

More than 10,000 American women each year choose planned homebirth with a homebirth midwife in the mistaken belief that it is a safe choice. In fact, homebirth with a homebirth midwife is the most dangerous form of planned birth in the US.

In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. In both the 2003 and 2004 Linked Birth Infant Death Statistics, mention was made of this data, but it was not included in the reports. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable. Homebirth increases the risk of neonatal death to double or triple the neonatal death rate at hospital birth.

As this chart shows, the neonatal mortality rate for DEM (direct entry midwife, another name for homebirth midwife) assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.

The chart shows the data for 2003-2004, but the data for 2005 has recently become available. Homebirth death continues to be far higher than death in the hospital for comparable risk women. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.

No wonder the Midwives Alliance of North American (MANA), the trade union for homebirth midwives, is suppressing their safety statistics. From 2001-2008, they have collected the single largest repository of data on homebirth. The data is publicly available, but only to those who can prove they will use them for the “advancement” of midwifery, and even then, a legal non-disclosure agreement must be signed as part of the process. MANA’s data may very well confirm that homebirth with a DEM has triple the neonatal mortality rate of hospital birth for comparable risk women in the same year.

What is also notable is that the results are consistent with all existing scientific studies, including the Johnson and Daviss study (Outcomes of planned home births with certified professional midwives: large prospective study in North America). Johnson and Daviss actually showed that homebirth with a CPM has a neonatal mortality rate almost triple that of hospital birth for low risk women. The latest statistics are the most recent and most reliable confirmation of that fact.

There really is no question about it. Homebirth with a homebirth midwife dramatically increases the risk of neonatal death.

*This blog post was originally published at Science-Based Medicine*

You may also like these posts

    None Found

Read comments »

9 Responses to “Homebirth Risks: Babies Three Times More Likely To Die”

  1. Hello says:

    Why has Dr. Amy not published these findings?

  2. persie says:

    This is American data. Canadian women who work within the medical system with highly trained Registered Midwives and have a choice of home birth if they are low-risk. This very recent study shows that home birth in Ontario is just as safe as a hospital birth. It studied almost 7000 women in each cohort. Perhaps the title of this article should be “American Midwives should be better trained and screen women wanting a home birth more rigorously”

  3. Rini says:

    Before you believe “Dr. Amy”, you might consider checking the data yourself. It paints a very different picture to me than it does to her. Grouping the data by Medical Attendant, I see 2.88 deaths per 1,000 for Certified Nurse Midwives (CNMs) and 3.69 deaths per 1,000 for Other Midwives. This is compared to the 7.17 deaths per 1,000 for MDs. Grouping by Birthplace and then Medical Attendant, we see that these figures are very close (2.70, 3.84, and 7.15 respectively) when we look only at “out of hospital” midwive-assisted births and only hospital births attended by an MD.

    That sounds to me like homebirths are twice as SAFE.

    Now granted, midwives select only the low-risk cases. This does place an unfair bias against hospital births. In order to meaningfully study the difference between hospital and home births, a randomized study would need to be conducted. Since most women want to choose their place of birth for themselves, this is not particularly feasible. So we work with the data we have.

    Note: I have seen this post (or a very similar one) before. In the comments of that previous post, Dr. Amy refuted numbers similar to those I have cited by claiming that those numbers look at the death rates within the first year of the child’s life. According to Dr. Amy, the “correct” numbers look at the death rates within the first 28 days of the child’s life. So – again, according to Dr. Amy – it doesn’t matter if your child lives to be a toddler; as long as they can survive on a ventilator in the hospital for at least a month, the medical system has not failed you.

    No, I don’t think so.

    I want to choose what gives my child the best chance of living a long and happy life. For me, these numbers support homebirth, with a midwife.

  4. Rini says:

    Oh yes, and as for the study cited by Dr. Amy near the end of the article, here is the conclusion pasted from the study abstract:

    “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. ”

    Similar mortality rates to hospital births, but with a lower rate of medical intervention. Sign me up!

    Oh, and Dr. Amy – if you would like to make a case comparing direct entry midwives to certified professional midwives, I am open to listening. However, I would expect such an article to avoid claiming that “homebirth” is dangerous as this article does. The studies cited here clearly show that homebirth is as safe as, if not more safe than, a hospital birth. Which brand of midwife you choose is an entirely different topic.

  5. Christina Miller says:

    I’m no Harvard school grad, and I may be from Mississippi, but the percentage math you are doing is certainly not anything I am familiar with. This is what I get:

    Births Deaths Mortality Rate
    CNM 375,387 140 .04%
    MD 4,240,989 2,606 .06%
    DEM 23,476 27 .12%

    To me the difference does not seem that significant, but the proper percentages definitely make a difference. A difference of .06 is a lot less than the aforementioned .54 of a difference.

    Just thought that I would make that know.

  6. Emily says:

    I am confused on where you found the information you are using in your article. I’ve searched through the links you have provided in the text and haven’t seen the information that support these claims. I couldn’t even find the chart you have. The statistics I found in these links look as though the infant mortality rate for home births is the same if not better than low-risk hospital births, and significantly better rates for medical intervention. Also, this chart only shows two types of midwife but there are others. The following are links that I got from your article that made me confused at the claims made in this article. Please help me to understand where you got this information. Thank you!
    This shows the CDC’s infant death records by medical attendent;jsessionid=CDF8A5664E3C356A8157D421FA11F1D6
    This shows the CDC’s infant death records by birth place. Notice how this only specifies hospital and non-hospital births. I believe one should take into consideration that the non-hospital births probably includes “other” in the first chart.

    Your last link showing the statistics of planned home births with a CPM seem pretty good to me.

  7. Jaci says:

    You’re joking right? You link to the Johnson and Daviss study stating that it makes that claim, yet all over that study is stated:

    “Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions. Our results are consistent with the weight of previous research on safety of home birth with midwives internationally. ”


    “Planned home births with certified professional midwives in the United States had similar rates of intrapartum and neonatal mortality to those of low risk hospital births

    Medical intervention rates for planned home births were lower than for planned low risk hospital births”

  8. Jay says:

    I am doing research comparing the overall mortality rates of home births vs hospital births. I have no major leaning one way or the other on this topic, but it is clear from your post that you are reacting emotionally to this topic. Just because something is twice as likely to happen does not mean it’s likely to happen. This is a classic example of using statistics in a misleading fashion. The bottom line is that mortality rates per 1000 are similar for home births (slight over 1) and hospital births (slightly under 1). I wish accomplished medical professionals like yourself would strive to understand why women choose home births and try to help the established medical community improve in areas that drive women away from hospitals.

  9. Linda Perry says:

    I will start by admitting my bias from the beginning: I am a CPM (Certified Professional Midwife) as well as a CM ( Certified Midwife). I attend both home and hospital births. There are GLARING errors in Dr. Amy’s little “Fact Sheet”. For one, DEM does not translate to homebirth midwife. DEM is a designation for a midwife who has not met any particular educational training standards.

    Certified Professional Midwives are Certified by NARM, a national and legally defensible certification. They attend mainly homebirths or birth center births.

    Certified Nurse Midwives and Certified Midwives are Certified by the American College of Nurse Midwives. They attend hospital births, but also home and birth center as well. Surprise!

    This study that was done is an embarrassment to the medical world, as it is incredibly flawed. For one thing, miscarriages, and women who accidentally delivered in the taxi on the way to the hospital, were counted as a home birth. So much for scientific rigor. Other, well-conducted studies have shown quite the opposite. Low risk women have excellent outcomes when attended by well-trained midwives.

    A little food for thought: all those NICU units in the hospital are filled with babies that were born there. In 19 years of home birth practice, I have had zero home birth babies in the NICU unit.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »