Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004

Objective: Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (1.0%) and are not supported by the American College of Obstetrics and Gynecology (ACOG). The primary objective of this analysis was to examine the safety of certified nurse midwife attended home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries. Study Design: United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital other midwife, home certified nurse midwife, home other midwife, and free-standing birth center certified nurse midwife deliveries. Result: For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital other midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home other midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths614), 0.4 (deaths7), 1.0 (deaths14), 1.8 (deaths75), and 0.6 (deaths16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45). Conclusion: Deliveries at home attended by CNMs and other midwives were associated with higher risks for mortality than deliveries in-hospital by CNMs.