A Home Obstetric Service With Expert Consultation and Back‐Up

Abstract

The medical literature comparing home and hospital obstetric outcomes is reviewed. A home obstetric service with hospital and obstetrician back-up is described, including screening, care during pregnancy and delivety and management of complications. Of 495 women who were accepted for home delivery, 77 miscarried or moved, 49 changed to hospital delivery, 19 had premature labor, and 61 were transferred to the hospital during labor. Maternal and perinatal mortality and morbidity are described. In this well-selected low risk population, careful prenatal and intrapartum care resulted in outcomes which are comparable to those of hospital programs. (Birth Family J 5:3, Fall 19 78)

A feminist perspective on the study of home birth *1Application of a midwifery care framework

“…Since the homebirth movement began in the 1970s, there have been several descriptive studies of home birth. Many of these studies show equal or superior outcomes for planned home births attended by physicians, direct entry, or nurse‐midwives, compared with hospital populations of similar risk (19–22), or compared with overall perinatal morbidity and mortality rates (23, 24). Although they did not provide comparable control groups, these studies have made an important contribution in separating myth from reality concerning home birth, and have demonstrated good outcomes for low‐risk women.…”

“…Although home birth advocates have claimed superior outcomes without qualifying the highly selective nature of the home birth population, anti‐home birth commentators have made home birth appear dangerous by not distinguishing unplanned, precipitous, premature, and unattended home births from planned, attended, and prenatally screened home births. Several studies, including one in North Carolina, one in Kentucky, and two in California, have demonstrated significant differences between planned and unplanned home birth outcomes (20–22, 24).…”

Physician- and midwife-attended home births Effects of breech, twin, and post-dates outcome data on mortality rates

“…Many studies have reported positive outcomes for home birth (1–26), including births attended by apprentice‐trained midwives 1 and certified nurse‐rnidwives in the United States and births attended by direct‐entry midwives in Canada and the Netherlands. However, there is an ongoing debate regarding whether it is safe for any provider to attend breech deliveries, twin deliveries, and post‐dates pregnancies at home.…”