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Planned Home Births

Outcomes Among Medicaid Women in Washington State

Executive Summary

This study describes birth outcomes, maternal characteristics, and prenatal care for women with planned home births who gave birth between 1989 and 1994. Women with home births are compared to other women who received prenatal care from licensed midwives and gave birth in birthing centers or in hospitals. These groups are also compared to the general Medicaid population of women who gave birth. The First Steps Database was used to determine the specialty of prenatal care provider and the birth place type, and as the data source for other measures of interest.

Women who received prenatal care from licensed midwives were assumed to be planning (or at least considering) home birth. It was not possible in this study to determine the planning status (i.e., whether the birth place was planned to be at home) for women with home deliveries and a prenatal care provider other than a licensed midwife, and for this reason the study focused on women who received prenatal care from licensed midwives.

• Birth outcomes for home deliveries were striking for their very low rates of poor outcomes. For women who received prenatal care from licensed midwives, the majority (85% to 100%) of those who would subsequently deliver infants with poor outcomes were transferred for hospital delivery at some point prior to birth.

• Women who delivered at home and received prenatal care from licensed midwives were typically low risk with respect to established risk factors for adverse birth outcomes: they were mostly white, older, married, non-smokers, and highly educated. Many of the same risk factors may predict successful home delivery. Those who were successful in delivering at home tended to be older, even more highly educated, more non-smoking, and financially better off, compared to those who subsequently delivered in hospital. Women who delivered at home and received prenatal care from licensed midwives also demonstrated low risk characteristics regarding their use of prenatal care: they started prenatal care early in their pregnancies; women who delivered at home received considerably more prenatal care from licensed midwives than did women who delivered in hospital.

• For the women identified as receiving some prenatal care from licensed midwives, the infant mortality rate was nearly 1.5 times that for all other Medicaid women although this difference was not statistically significant. Major malformations and chromosomal abnormalities (Down Syndrome, Trisomy 18, diaphragmatic hernia, and conjoined twins) identified as causes of death or underlying medical conditions in the infant deaths occurred with a significantly higher frequency. This was not explained by the older age of the women with prenatal care from licensed midwives.

The results of this study are consistent with a large body of literature which has documented the safety of planned home birth for low risk women when attended by a trained provider.

Modified: Tuesday August 15 2006

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