New study shows how homebirth COULD be safe in the US

To date there has not been a single US study that shows that homebirth in the US is safe. All the existing studies show that US birth at home has a perinatal death rate from 3-9X higher than comparable risk hospital birth.

Until now.

A recently published study from Washington State shows how homebirth COULD be safe in the US by applying strict eligibility requirements, the same requirements that apply to out of hospital birth in countries like Canada, the UK and the Netherlands.

The paper is Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State.

The study population included 10,609 births: 40.9% planned home and 59.1% planned birth center births. Intrapartum transfers to hospital were more frequent among nulliparous individuals (30.5%; 95% CI 29.2–31.9) than multiparous individuals (4.2%; 95% CI 3.6–4.6). The cesarean delivery rate was 11.4% (95% CI 10.2–12.3) in nulliparous individuals and 0.87% (95% CI 0.7–1.1) in multiparous individuals. The perinatal mortality rate after the onset of labor (intrapartum and neonatal deaths through 7 days) was 0.57 (95% CI 0.19–1.04) per 1,000 births. Rates for other adverse outcomes were also low. Compared with planned birth center births, planned home births had similar risks in crude and adjusted analyses.


Rates of adverse outcomes for this cohort in a U.S. state with well-established and integrated community midwifery were low overall. Birth outcomes were similar for births planned at home or at a state-licensed, freestanding birth center.

These two charts summarize the outcomes:


Why doesn’t this show that homebirth and birth center birth in Washington State is safe? There are two reasons.

First, the study included only those midwives in Washington State who are members of the Midwives Association of Washington State (MAWS) and only those who participate in data collection.

As the authors note:

…[O]ur findings must be interpreted in the context of several limitations. Because some Washington midwives are not Midwives’ Association of Washington State members or do not participate in data collection, our study population is representative of this organization’s members and may not include all planned community births in the state during our study period.

Second, the study includes only those who met the STRICTER eligibility requirements of the study, NOT everyone who planned to give birth with a participating MAWS member outside the hospital. More than 7% of the homebirths attended by MAWS members did not meet the eligibility requirements used in other countries.

…[R]esults reported in this study may not be generalizable to states with different legislation, training, and integration of community midwives.

This study confirms what we already know. Out of hospital birth in the US COULD be safe if midwives practiced according to established international guidelines. Sadly for women choosing out of hospital birth in the US, they often fail to do so. Therefore out of hospital birth in the US is still not safe.

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