Washington State

5. Licensed midwife-attended, out-of-hospital births in Washington State: are they safe?

By Janssen PA, Holt VL, Myers SJ
Birth 1994 Sep;21(3):141-8

This study found that it was just as safe to have a baby outside hospital, under the care of a licensed midwife, as to have a hospital delivery with doctors or Certified Nurse-Midwives in attendance.The authors compared out-of-hospital births, attended by licensed midwives, to those attended by doctors and Certified Nurse-Midwives. Low birthweight, low Apgar scores, neonatal and postneonatal mortality were recorded. No significant differences in Apgar scores or mortality were noted. The out-of-hospital midwife deliveries were less likely to produce low-birthweight babies. Looking at only low-risk mothers, licensed midwives and certified nurse-midwives were both less likely to deliver low-birthweight babies than doctors. Similar results have been found in other studies, and personally I find this slightly confusing; how could the place of birth have any influence on the birthweight of the baby?My guesses at possible reasons for this: premature babies are more likely to be delivered in hospital, by doctors, which would increase the number of low-birthweight babies in the hospital group. But confining results to low-risk women should remove most of these cases. Inductions are less common in home-birth bookings (see several studies above), which reduces the risk of accidental early delivery and hence low birthweight. If you have any other information on this subject, I would be pleased to hear from you.The authors concluded that ‘The results of this study indicate that in Washington state the practice of licensed non nurse-midwives, whose training meets standards set by international professional organizations, may be as safe as that of physicians in hospital and certified nurse-midwives in and out of hospital.‘ Read abstract on Medline

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