Declercq ER: Out-of-hospital births
, US, 1978: Birthweight and Apgar
In a 1994 study reported in the medical journal Birth, 6,944 midwife-attended, planned out-of-hospital births
were scrutinized by researchers and outcomes were found to be comparable or better than those obtained by physicians in hospitals.
Out-of-hospital births also were associated with fewer obstetrical procedures, and with increased odds of unassisted vaginal delivery.
Misclassifying these births as simply "in hospital" according to the previous statistical methods "caused rates of adverse outcomes among planned out-of-hospital births to be underestimated (in some cases, substantially),'' the investigators said (N Engl J Med.
Sarasota has many practicing midwives and a much higher rate of out-of-hospital births
than the rest of the country-5 percent in Sarasota, versus a national average of 1-2 percent.
(5) A DEM "is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing"(http://www.mana.org); unlike CNMs, they typically attend out-of-hospital births
Preventing out-of-hospital births
among high-risk women might help reduce the number of homicides on the day of birth.
The possible other factors considered include changes in Medicaid eligibility, frequency of out-of-hospital births
, and changes in medical practice or the actual frequency of morbidity in the population.
All agreed it would be useful to have up-to-date information such as the number of midwives in a country, the number of births and the outcomes of both in-hospital and out-of-hospital births
. This type of information would give ICM evidence on which to base its arguments in favour of normal birth.
As the analysts comment, these findings are important to consider, given the increased popularity of out-of-hospital births
in recent years.
This study surveys incidence of neonatal mortality and low birth weight in out-of-hospital births
. It divides the 809 births surveyed into two groups: 575 planned homebirths and 234 unplanned.