OUTCOMES OF INTENDED HOME BIRTHS IN NURSE-MIDWIFERY PRACTICE - A PROSPECTIVE DESCRIPTIVE STUDY

Objective: To describe the outcomes of intended home birth in the prac tices of certified nurse-midwives. Methods: Twenty-nine US nurse-midwi fery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for all enrolled women were asce rtained. Validity and reliability of submitted data were established. Results: Of 1404 enrolled women intending home births, 6% miscarried, terminated the pregnancy or changed plans. Another 7.4% became ineligi ble for home birth prior to the onset of labor at term due to the deve lopment of perinatal problems and were referred for planned hospital b irth. Of those women beginning labor with the intention of delivering at home, 102 (8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were transferred to the hospital after delivery, and 1 4 infants (1.1%) were transferred after birth. Overall intrapartal fet al and neonatal mortality for women beginning labor with the intention of delivering at home was 2.5 per 1000. For women actually delivering at home, intrapartal fetal and neonatal mortality was 1.8 per 1000. C onclusion: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evi dence of meconium passage. (Obstet Gynecol 1998;92:461-70. (C) 1998 by The American College of Obstetricians and Gynecologists.)