title: Perinatal risks of planned home births in the United States.
abstract: OBJECTIVE
  We analyzed the perinatal risks of midwife-attended planned home births in the United States from 2010 through 2012 and compared them with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) for planned home births.
  
  
  METHODS
  Data from the US Centers for Disease Control and Prevention's National Center for Health Statistics birth certificate data files from 2010 through 2012 were utilized to analyze the frequency of certain perinatal risk factors that were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives. Home birth deliveries attended by others were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP.
  
  
  RESULTS
  Midwife-attended planned home births in the United States had the following risk factors: breech presentation, 0.74% (odds ratio [OR], 3.19; 95% confidence interval [CI], 2.87-3.56); prior cesarean delivery, 4.4% (OR, 2.08; 95% CI, 2.0-2.17); twins, 0.64% (OR, 2.06; 95% CI, 1.84-2.31); and gestational age 41 weeks or longer, 28.19% (OR, 1.71; 95% CI, 1.68-1.74). All 4 perinatal risk factors were significantly higher among midwife-attended planned home births when compared with certified nurse midwives-attended hospital births, and 3 of 4 perinatal risk factors were significantly higher in planned home births attended by non-American Midwifery Certification Board (AMCB)-certified midwives (other midwives) when compared with home births attended by certified nurse midwives. Among midwife-attended planned home births, 65.7% of midwives did not meet the ACOG and AAP recommendations for certification by the American Midwifery Certification Board.
  
  
  CONCLUSIONS
  At least 30% of midwife-attended planned home births are not low risk and not within clinical criteria set by ACOG and AAP, and 65.7% of planned home births in the United States are attended by non-AMCB certified midwives, even though both AAP and ACOG state that only AMCB-certified midwives should attend home births.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY. Electronic address: amg2002@med.cornell.edu.
authors.forename: Amos
authors.initials: A
authors.lastname: Grünebaum
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY; Departments of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, and Alfred I. DuPont Hospital for Children, Wilmington, DE.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Brent
authors.affiliation: Center for Mother and Child, Philipps University, Marburg, and Clara Angela Foundation, Berlin, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.affiliation: Division of Pediatrics and Child Health, University of Leeds, Leeds, England, UK.
authors.forename: Malcolm I
authors.initials: MI
authors.lastname: Levene
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Chervenak
mesh_terms: D002568:Certification; D016208:Databases, Factual; D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008880:Midwifery / Q000592:standards / Q000706:statistics & numerical data*; D009721:Nurse Midwives / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012307:Risk Factors; D014481:United States
keywords: home birth; midwives; perinatal risks