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CPM 2000 study published in BMJ

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CPM 2000 Study Published! (long message)

Grassroots Network Message 506012
CPM 2000 Study Published! (long message)

Dear Friends,

The long-awaited study of home births attended by CPMs during the year
2000 is finally here!

"Outcomes of planned home births with certified professional midwives:
large prospective study in North America." Kenneth C Johnson, senior
epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416
(18 June).

The BMJ has published the paper on-line. Read it at

Published in the June 18 issue of the North America British Medical
Journal, the study found that "planned home births for low risk women
in the United States are associated with similar safety and less
medical intervention as low risk hospital births" according to the BMJ
press release (see below).

Co-author Ken Johnson has stated that this is the largest study of its
kind at this time. The study is prospective (initial data submitted
before the birth took place, so no births could be "left out") and
includes data from more than 5000 births in the U.S and Canada. This
study cannot be written off for being too small or not relevant to US
populations and circumstances.

The BMJ also has a "rapid response" feature, where readers can post
letters about articles (comments, responses, etc.). As the BMJ states:
"Think of Rapid Responses as electronic letters to the editor." On
the BMJ home page find "Interactions" in the menu list on
the left, and choose "Rapid Responses" for more information. CfM is
posting a rapid response shortly.

Would you like to see your local newspaper report about this study?
The BMJ will have posted their press release to wire services, but
this study may not be considered hot news by very many newspapers.
However, midwifery advocates all over the country can help get news
attention on this study, especially if your state is working on
midwifery legislation. You may even be able to use this study as a
way to bring a fledgling group and its work to positive public
attention. The best situation is when someone already has a
relationship with a news reporter at your local newspaper (you have
talked with them before, you have given them any news tips, etc.).
Call up your contact and talk with them about this study and its
relevance in your community, offer them the BMJ press release (see
below) and additional information from author Betty-Anne Daviss (see
below). If you have a local birth network or birth-related advocacy
group of any kind, make sure to let the reporter know how the study is
relevant to your group and what it is doing. If you don't already have
a contact at your local paper, you could use this study as a reason to
pick up the phone and begin a relationship.

When you read the study (it is not difficult to understand), you will
find many points that can be made; here are a few to start with:
· The study demonstrates unequivocally that for "low risk"
mothers, home birth attended by a CPM results in outcomes comparable
to low risk births in the hospital - ie CPM-attended planned home
births are safe for mothers and babies.
· Despite the fact that the midwives in the study included
many who were not well-integrated into the health care system, mothers
and babies that did need medical attention were appropriately
identified and transported to hospitals and got the care they needed;
otherwise, we would not see the good outcomes that are comparable to
hospital birth outcomes.
· Substantially fewer interventions were performed on mothers
planning home births than on comparable mothers giving birth in
hospitals, which suggests that many of those interventions are
unnecessary. Such unnecessary interventions are costly and are
associated with increased complications for mothers and babies.

Overall, the study shows that for healthy women, a planned home birth
with a trained midwife (ie, a CPM), is a safe and reasonable choice
for maternity care, supported by the evidence. If maternity care is
"scientific" women everywhere should have access to midwives and
out-of-hospital birth.

You are welcome to post this grassroots network message in its
entirety to other e-lists you may be on. You may also forward either
or both of the press releases to anyone.

Susan Hodges, "gatekeeper"

Press Release from BMJ

Planned home births in the United States are safe, say researchers

Outcomes of planned home births with certified professional midwives:
large prospective study in North America BMJ Volume 330, pp [to be

Planned home births for low risk women in the United States are associated
with similar safety and less medical intervention as low risk hospital
births, finds a study in this week's BMJ.

Midwives involved with home births are often not well integrated into the
healthcare system in the United States and evidence on the safety of such
home births is limited.

In the largest study of its kind internationally to date, researchers
analysed over 5000 home births involving certified professional
midwives across the United States and Canada in 2000. Outcomes and
medical interventions were compared with those of low risk hospital

Rates of medical intervention, such as epidural, forceps and caesarean
section, were lower for planned home births than for low risk hospital
births. Planned home births also had a low mortality rate during
labour and delivery, similar to that in most studies of low risk
hospital births in North America.

A high degree of safety and maternal satisfaction were reported, and
over 87% of mothers and babies did not require transfer to hospital.

"Our study of certified professional midwives suggests that they
achieve good outcomes among low risk women without routine use of
expensive hospital interventions," say the authors. "This 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 United States."

Kenneth Johnson, Senior Epidemiologist, Surveillance and Risk Assessment
Division, Center for Chronic Disease Prevention and Control, Public Health
Agency of Canada, Ottawa, Canada
Tel: +1 613 957 0339
To arrange an interview, please call Aggie Adamczyk: +1 613 941 8189
(Public Health Agency media contact)
Email: [email protected]

Betty-Anne Daviss, Project Manager, FIGO Safe Motherhood/Newborn
Initiative, Housed at The Society of Gynaecologists and Obstetricians
of Canada, 780 Echo Drive, Ottowa, Canada
tel: +1 800 561 2416 OR +1 613 730 4192 Ext. 263
Email: [email protected]

Further Information from co-author Betty-Anne Daviss:

The British Medical Journal has embargoed a press release until
tomorrow (up on their website at regarding the largest study
ever done of its kind on home birth. What the press release does not
point out is that it was conducted by two Canadian researchers who
live in Ottawa -- a Canadian epidemiologist and a Canadian midwife.

It was carried out on all clients having a delivery with a certified
professional midwife for a given time period and reports on 5, 418

The majority of the births were done by American midwives but Canadian
midwives were also included in the study.

The study shows that -- if you aren't a high risk Mom carrying twins,
having a premature baby or baby coming bottom first, all of which can
be judged ahead of time -- your chance of having a healthy normal safe
delivery are the same whether you plan a home or hospital birth.
However, if you choose the home birth your intervention rates will be
a tenth to a half of what they would be in hospital, compared to
figures of the same time period from the National Health Institute of
the US.

The study is groundbreaking because former studies have been
criticized for not being big enough, for not being able to distinguish
between planned or unplanned births, and for being retrospective, that
is only looking at old records as opposed to engaging health
professionals in the requirement of registering births they were going
to do and then having to account for all outcomes. As well, over 500
mothers were phoned to verify whether what the midwives said at the
births actually happened.

The study suggests that legislators and policy makers should pay
attention to the fact that this study supports the American Public
Health Association resolution to increase out of hospital births done
by direct entry midwives.

The American College of Obstetricians and Gynecologists still opposes
home birth. The SOGC has written a statement acknowledging that women
have the right to choose their place of birth.

Betty-Anne Daviss, Registered Midwife
co-principal investigator of the study
I am at the Society of Obstetricians and Gynaecologists of Canada
meeting in Quebec City. You could reach me through the SOGC media
person Kelly Nolan at (613)730-4192 but it appears her cell has not
been working well and she is involved in another story, on several
representatives from low resource
countries visiting Canada to meet regarding an ongoing partnership
they have with the SOGC. I will be registering at the Delta Hotel in
Quebec City here some time later today, but will come and check my
emails every hour or so. This email address may be the best way to get
in touch. If you leave a number I can phone you if you are interested
in the story.

You can also reach Ken Johnson at (613) 957-0339 during the day, and
(613) 730-0282 at night.
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Our dd's birth was part of that study- I'd forgotten all about it!
Finally a huge study with undeniable findings!

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