A 2000 study of home births in the US and Canada concluded that planned home births attended by certified professional midwives resulted in lower rates of medical intervention than their low risk counterparts at hospitals. For example, in the hospital 33% of the women received episiotomies compared to 2.1% of the women who began their labor at home. The caesarean rate was 19% of the low risk births in the hospital. For intended home births in the study, the caesarean rate was 3.7%.

No maternal deaths occured. Neonatal and intrapartum mortality rates were about the same at home or the hospital.

The study followed 5418 women who planned to deliver at home, of which 12% were transferred to the hospital during labor (more than half for failure to progress, pain relief, or exhaustion). Transfer rates were highest for women giving birth for the first time.

In the United States, where birth has become “an economic, medical, and industrial enterprise” costs for an uncomplicated vaginal birth in a hospital are about three times those of home births.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions. Our results are consistent with the weight of previous research on safety of home birth with midwives internationally. 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. We recommend that these findings be taken into account when insurers and governing bodies make decisions about home birth and hospital privileges with respect to certified professional midwives.”