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Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004



Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (<1.0%) and are not supported by the American College of Obstetrics and Gynecology (ACOG). The primary objective of this analysis was to examine the safety of certified nurse midwife attended home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries.

Study Design:

United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital ‘other’ midwife, home certified nurse midwife, home ‘other’ midwife, and free-standing birth center certified nurse midwife deliveries.


For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital ‘other’ midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home ‘other’ midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45).


Deliveries at home attended by CNMs and ‘other midwives’ were associated with higher risks for mortality than deliveries in-hospital by CNMs.

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  1. Anderson RE, Anderson DA . The cost-effectiveness of home birth. J Nurse Midwifery 1999; 44: 30–35.

    Article  CAS  PubMed  Google Scholar 

  2. Henderson J, Petrou S . Economic implications of home births and birth centers: a structured review. Birth 2008; 35: 136–146.

    Article  PubMed  Google Scholar 

  3. Högberg U . Homebirths in a modern setting—a cautionary tale. Acta Obstet Gynecol 2008; 87: 797–799.

    Article  Google Scholar 

  4. Royal College of Obstetricians and Gynaecologists/Royal College of Midwives. Home births. Joint statement No. 2, April 2007, Accessed February 9, 2010.

  5. Society of Obstetricians and Gynaecologists of Canada. Midwifery. SOCGC Policy Statement No. 12. J Obstet Gynaecol Can 2003; 25 (3): 239. Accessed February 1, 2009.

    Article  Google Scholar 

  6. The American College of Obstetrics and Gynecology. ACOG statement on home births. Accessed January 30, 2009.

  7. Declercq ER, Paine LL, Winder MR . Home birth in the United States, 1989–1992: a longitudinal descriptive report of national birth certificate data. J Nurse Midwifery 1995; 40: 474–482.

    Article  CAS  PubMed  Google Scholar 

  8. Martin JA, Hamilton BE, Sutton PD, Ventura MA, Menacker F, Kirmeyer S et al. Births: final data for 2005. Natl Vital Stat Rep 2007; 56: 1–103.

    PubMed  Google Scholar 

  9. Schramm WF, Barnes DE, Bakewell JM . Neonatal mortality in Missouri home births, 1978–84. Am J Public Health 1987; 77: 930–935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Durand AM . The safety of home birth: the Farm study. Am J Public Health 1992; 82: 450–452.

    Article  Google Scholar 

  11. Woodcock HC, Read AW, Bower C, Stanley FJ, Moore DJ . A matched cohort study of planned home and hospital births in Western Australia 1981–1987. Midwifery 1994; 10: 125–135.

    Article  CAS  PubMed  Google Scholar 

  12. Anderson RE, Murphy PA . Outcomes of 11 788 planned home births attended by certified nurse- midwives. J Nurse Midwifery 1995; 40: 483–492.

    Article  CAS  PubMed  Google Scholar 

  13. Olsen O . Meta-analysis of the safety of home birth. Birth 1997; 24: 4–13.

    Article  CAS  PubMed  Google Scholar 

  14. Murphy PA, Fullerton J . Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol 1998; 92: 461–470.

    CAS  PubMed  Google Scholar 

  15. Janssen PA, Lee SK, Ryan EM, Etches DJ, Farquharson DF, Peacock D et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 2002; 166: 315–323.

    PubMed  PubMed Central  Google Scholar 

  16. Johnson KC, Daviss BA . Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005; 330 (7505): 1416.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Amelink-Verburg MP, Verloove-Vanhorick SP, Hakkenberg RMA, Veldhuijzen IME, Gravenhorst JB, Buitendijk SE . Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study. BJOG 2008; 115: 570–578.

    Article  CAS  PubMed  Google Scholar 

  18. Lindgren HE, Radestad IJ, Christensson K, Hildingsson IM . Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. a population-based register study. Acta Obstet Gynecol 2008; 87: 751–759.

    Article  Google Scholar 

  19. Mori R, Dougherty M, Whittle M . An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003. BJOG 2008; 115: 554–559.

    Article  CAS  PubMed  Google Scholar 

  20. Bastian H, Deirse MJNC, Lancaster PAL . Perinatal death associated with planned home birth in Australia: population based study. BMJ 1998; 317: 384–388.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Pang JWY, Heffelfinger JD, Huang GJ, Benedetti TJ, Weiss NS . Outcomes of planned home births in Washington state: 1989–1996. Obstet Gynecol 2002; 100: 253–259.

    PubMed  Google Scholar 

  22. National Center for Health Statistics. United States Linked Birth/Infant Death Period Public Use Files. Years 2000, 2001, 2002, 2003, and 2004. US Public Health Service: Hyattsville, MD.

  23. Malloy MH . Impact of cesarean section on neonatal mortality among very preterm infants: United States 2000–2003. Pediatrics 2008; 122: 1–8.

    Article  Google Scholar 

  24. SAS Institute Inc. SAS User's Guide: Statistics. version 9.1 edn. SAS Institute Inc: Cary, NC, 2002.

  25. Young D . Home birth in the United States: action and reaction. Birth 2008; 35: 263–265.

    Article  PubMed  Google Scholar 

  26. Anthony S, Buitendijk SE, Offerhaus PM, van Dommelen P, van der Pal-de Bruin KM . Maternal factors and the probability of a planned home birth. BJOG 2005; 112: 748–753.

    Article  CAS  PubMed  Google Scholar 

  27. Hildingsson IM, Lindgren HE, Haglund B, Radestad IJ . Characteristics of women giving birth at home in Sweden: a national register study. Am J Obstet Gynecol 2006; 195 (5): 1366–1372.

    Article  PubMed  Google Scholar 

  28. MacDorman MF, Declercq E, Menacker F, Malloy MH . Infant and neonatal mortality for primary cesarean and vaginal births to women with ‘no indicated risk,’ United States, 1998–2001 birth cohorts. Birth 2006; 33: 175–182.

    Article  PubMed  Google Scholar 

  29. Burnett CL, Jones JA, Rooks J, Chen CH, Tyler CW, Miller CA . Home delivery and neonatal mortality in North Carolina. JAMA 1980; 244: 2741–2745.

    Article  PubMed  Google Scholar 

  30. Freeman MA, Gay GA, Brokert JE, Potrzebowski PW, Rothwell CJ . The 1989 revisions of the US standard certificates of livebirth and death and the US standard report of fetal death. Am J Public Health 1988; 78: 168–172.

    Article  Google Scholar 

  31. Buescher PA, Taylor KP, Davis MH, Bowling JM . The quality of the new birth certificate data: a validation study in North Carolina. Am J Public Health 1993; 83: 1163–1165.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Lydon-Rochelle MT, Holt VL, Cardenas V, Nelson JC, Easterling TR, Gardella C et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol 2005; 193: 125–134.

    Article  PubMed  Google Scholar 

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I gratefully acknowledge the review of this manuscript and suggestions made by Dr Martin G Myers and Dr George Saade. Part of this analysis was accepted for presentation in poster form at the Annual Meeting of the Pediatric Academic Societies in Baltimore, MD, in May 2009.

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Correspondence to M H Malloy.

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Malloy, M. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004. J Perinatol 30, 622–627 (2010).

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  • home births
  • certified nurse midwife
  • neonatal mortality

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