title: Outcomes of planned home births attended by certified nurse-midwives in southeastern Pennsylvania, 1983-2008.
abstract: BACKGROUND
  In this study, we examined the perinatal outcomes of planned home births over a 25-year period (1983-2008) in a group of primarily Amish women (98%) attended by certified nurse-midwives (CNMs) in southeastern Pennsylvania.
  
  
  METHODS
  This was a retrospective, descriptive analysis of data (N = 1836 births) from several CNM practices. Data were abstracted for 25 items, including demographics, labor, and birth. Initially, 2 investigators abstracted 15 records to compare assessments and standardize definitions. Charts were then divided and abstracted individually by one investigator. Several relationships were examined in 2 by 2 tables using the chi-square procedure for the difference in proportions. Maternal and newborn transfers to the hospital were included in the analysis.
  
  
  RESULTS
  Of the women who planned home birth for 1836 pregnancies, 1733 of the births occurred at home. Although more than one-third of the women were of high parity (gravida 5-13), rates of postpartum hemorrhage were low (n = 96, 5.5%). There were no maternal deaths. Nearly half of the maternal transfers to the hospital (n = 103, 5.6%) were for ruptured membranes without labor (n = 25, 1.4%) and/or failure to progress (n = 23, 1.3%). The neonatal hospital admission rate also was low (n = 13, 0.75%). Of the 7 (0.4%) early neonatal deaths, all were attributed to lethal congenital anomalies that are common to this population.
  
  
  CONCLUSIONS
  This study is the first to describe the outcomes of planned home births in a primarily Amish population cared for by CNMs. It also adds to the literature on planned home births in the United States and supports the findings from previous studies that women who have home births attended by CNMs have safety profiles equal to or better than profiles of women who had hospital births in similar populations.
authors: University of New Mexico College of Nursing, MSC 09 5350, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA. KJCox@salud.unm.edu
authors: Kim J
authors: KJ
authors: Cox
authors: Ruth
authors: R
authors: Schlegel
authors: Pat
authors: P
authors: Payne
authors: Dusty
authors: D
authors: Teaf
authors: Leah
authors: L
authors: Albers
mesh_terms: D000328:Adult; D061365:Amish; D016009:Chi-Square Distribution; D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D020073:Gravidity; D006700:Home Childbirth / Q000009:adverse effects; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008880:Midwifery; D009721:Nurse Midwives; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D010343:Patient Admission; D010414:Pennsylvania / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012421:Rupture; D055815:Young Adult