Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Recorded presentation

Saraswathi Vedam, MSN, CNM, School of Nursing, Yale University, 943 Boston Post Rd, Madison, CT 06443, 203-318-8884, saraswathi.vedam@yale.edu and Deren E. Bader, CPM, DrPH, Division of Research, Midwives Alliance of North America, PO Box 6310, Charlottesville, VA 22906.

BACKGROUND: In the United States, safety of home birth remains controversial. Sources of information have been limited to studies with recognized methodological flaws. Investigations have failed to distinguish between planned and unplanned birth, to accurately classify outcomes when transfer of care occurs, to control for provider type, to define inclusion criteria for home birth subjects and to adequately correlate specific adverse outcomes with birth setting. Critical reviews have described methods to improve quality and external validity of home birth trials. In the last decade, investigators have had the opportunity to apply these methods. OBJECTIVE: To assess the evidence on safety of home birth, and identify evidence-based implications for health care policy and practice. SEARCH STRATEGY: We searched Medline, Cinahl, Cochrane, Scopus, and PubMed using the mesh heading “home childbirth”. We restricted our search criteria to studies published from 1995-2005. Primary inclusion criteria included: planning status identified or ability to distinguish between planned and unplanned home births. ANALYSIS: Two reviewers independently assessed quality of studies according to: study design, sample size and characteristics, relevant comparison group, relevant outcome measures, and method to track outcomes in transfer of care. Perinatal outcomes and interventions commonly reported by high quality trials were compared. CONCLUSION: Recent controlled trials have established that planned home births can achieve excellent perinatal outcomes with low rates of medical intervention. In an era of evidence-based practice and rising health care costs, there is adequate evidence to support an integrated system of midwives and physicians attending births in all settings.

Learning Objectives: At the end of this session participants will be able to

• Identify 3 key methodological problems with published home birth research
• List 3 of the common reasons for transfer from planned home birth to a hospital
• Describe 3 of the conditions which contribute to safety of planned home birth (selected women, qualified providers, basic equipment, access to hospitalization, etc)

Keywords: Access to Health Care, Evidence Based Practice

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation