The results of a large, prospective study (published in the British Medical Journal) provide further evidence that home can be better than hospital for giving birth, when supported by a certified midwife.

The research was based on the outcomes of 5418 births in women who intended to give birth at home with the help of a direct entry midwife when labor began. Rates of neonatal and intrapartum mortality were similar to those detected in most studies of low-risk hospital births in the same region, while the incidence of medical interventions, including epidural, episiotomy, and forceps, vacuum, and cesarean delivery, were significantly reduced.

"The evidence supports the American Public Health Association's recommendation to increase access to out of hospital maternity care services with direct entry midwives in the USA," comment study authors Kenneth Johnson (Public Health Agency of Canada) and Betty-Anne Daviss (International Federation of Gynecology and Obstetrics, Canada).

ObGynWorld.com article (requires login and registration)

PubMed article (no registration required)

I read the article above and grappled with the challenges of giving birth within the US healthcare system which does not systematically provide a full spectrum of health care options for women.  I'm referring to the disconnect between midwives and OBs and the difficult, sometimes hostile environment in which most homebirth midwives must provide services.

Worldwide statistics place the US 17th in terms of maternal mortality and 7th in terms of infant mortality (source: UNICEF and World Health Organization).

Most other countries that have better outcomes for mothers and babies have midwives integrated into the healthcare delivery system.   Midwives provide care for 'low-risk', generally healthy women. Midwives refer to obstetricians those who are considered high-risk or whom are not well and need the additional specialized care.

Part of what is causing the disconnect in the US is our economic model, which sometimes blurs and obscures the benefits of certain care, etc., for financial gain. 

If you read the full research results in PubMed, you'll notice that giving birth at home for the low-risk woman is not only safer, it cost 3x less than giving birth in the hospital.  Imagine if even 20% of women in the US gave birth at home (there are over 4.2 million babies born each year in the US ) what a cost savings that would be!

Based on our economic model, women (and men) in the USA who want the very best healthcare for women and infants will be most successful at causing the long overdue changes necessary by demanding it as healthcare consumers .  When economic pressure is brought to bear in our system, change occurs.

I invite you to:

•  learn about your options for your reproductive health and the health of your infant children.

•  become educated about the current state of affairs with regard to women's health care and midwifery specifically in your local area.

•  contact your local political representatives to demand that women's and infants' healthcare be made a higher priority in legislation.

•  Locate the midwives in your community (some work in the home, birth center or hospital environments) and become familiar with their services and offerings, especially if you are a healthy, 'low-risk' woman.

•  Use midwifery care for birth AND wellness if you're considered a 'low-risk' woman.

•  Contact your insurer and confirm that midwifery care (for birth and wellness) is covered by them.  If not, put in writing to the insurer and your employer your request for midwifery care to be covered.

Sandy Caldwell is an IWL alumna, IWL eNews editor, certified birth/postpartum doula, childbirth mentor-candidate and activist. She is passionate about women's healthcare and continually educates herself on these topics. Email