AMCHP Webinar, July 11, 2013 A Home Birth Primer for MCH Programs Geradine Simkins, RN, CNM, MSN Midwives Alliance, Executive Director . Benefits of planned home birth: Home births promote normal physiologic birth. WHO (1996) call for elimination of unnecessary interventions in childbirth
some of the worst outcomes
Why Home Birth?A woman’s perspective(Jackson 2012, Blix 2011, Lindgren 2010, Hendrix 2010, Hildingsson 2010, Janssen 2006, Davies 1996, Cunningham 1993)
Control of environment and process of care
Midwives provide high-quality care at home births
meeting national & international standards
Professional competencies recommended by AAP Policy Statement on Planned Home Birth (2013)—medical equipment, emergency transfer plans, thorough newborn exams, and so forth—are integrated into the practice of credentialed midwives
regardless of place of birth
In the rare cases when newborns require consultation or referral, infants are transferred to the tertiary care system, and pediatricians where available, for active management
Data source and years: The MANA Statistics Registry, 2004 – 2009.
Total dataset: 24,848; planned home births: 16,924 planned home births
(2012) MANA Division of Research Update: Research Roundup. Midwives Alliance Annual Conference, Asilomar, CA.
US maternity care most costly in the world
High cost to insurers and Medicaid programs
Midwives keep costs down while increasing access to high quality of care
1. Planned home birth means appropriate use of intervention, focusing on safe, healthy, normal physiologic birth
2. Planned home birth is cost effective
3. Midwives (as the main home birth providers) improve access to high quality maternity care
MCH programs could increase access to high quality, cost effective maternity care, and promote health equity, by facilitating Medicaid coverage of midwifery services for all women, in allbirth settings
American Way of Birth, Costliest in the World, New York Times, June 30, 2013. http://mobile.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html. http://truvenhealth.com/
Blix, E. (2011). Avoiding disturbance: midwifery practice in home birth settings in Norway. Midwifery, 27(5), 687–692. doi:10.1016/j.midw.2009.09.008
Cost of Having A Baby in the United States, http://www.chqpr.org/downloads/CostofHavingaBaby.pdf
Cunningham, J. D. (1993). Experiences of Australian mothers who gave birth either at home, at a birth centre, or in hospital labour wards. Social science & medicine (1982), 36(4), 475–483.
Davies, J., Hey, E., Reid, W., & Young, G. (1996). Prospective regional study of planned home births. Home Birth Study Steering Group. BMJ (Clinical research ed.), 313(7068), 1302–1306.
Hatem, M., Sandall, J., Devane, D., Soltani, H., & Gates, S. (2008). Midwife-led versus other models of care for childbearing women. Cochrane database of systematic reviews (Online), (4), CD004667. doi:10.1002/14651858.CD004667.pub2
Hendrix, M., Pavlova, M., Nieuwenhuijze, M. J., Severens, J. L., & Nijhuis, J. G. (2010). Differences in preferences for obstetric care between nulliparae and their partners in the Netherlands: a discrete-choice experiment. Journal of psychosomatic obstetrics and gynaecology, 31(4), 243–251. doi:10.3109/0167482X.2010.527400
Hildingsson, I., Rådestad, I., & Lindgren, H. (2010). Birth preferences that deviate from the norm in Sweden: planned home birth versus planned cesarean section. Birth (Berkeley, Calif.), 37(4), 288–295. doi:10.1111/j.1523-536X.2010.00423.x
How to Save $5 Billion in Healthcare Spending for Employers & Taxpayers, http://chqpr.org/blog/index.php/2013/01/how-to-save-5-billion-in-healthcare-spending-for-employers-and-taxpayers/
Jackson, M., Dahlen, H., & Schmied, V. (2012). Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths. Midwifery, 28(5), 561–567. doi:10.1016/j.midw.2011.11.002
Janssen, P. A., Carty, E. A., & Reime, B. (2006). Satisfaction with planned place of birth among midwifery clients in British Columbia. Journal of midwifery & women’s health, 51(2), 91–97. doi:10.1016/j.jmwh.2005.10.012
Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ : Canadian Medical Association Journal, 181(6-7), 377–383. doi:10.1503/cmaj.081869
Lindgren, H. E., Rådestad, I. J., Christensson, K., Wally-Bystrom, K., & Hildingsson, I. M. (2010). Perceptions of risk and risk management among 735 women who opted for a home birth. Midwifery, 26(2), 163–172. doi:10.1016/j.midw.2008.04.010
MacDorman, M., TJ Mathews & E DeClercq, Homebirth in the United States-1990-2009, January 2012. http://www.cdc.gov/nchs/data/databriefs/db84.pdf
Olsen, O., & Clausen, J. A. (2012). Planned hospital birth versus planned home birth. Cochrane database of systematic reviews (Online), 9, CD000352. doi:10.1002/14651858.CD000352.pub2
Schroeder, E., Petrou, S., Patel, N., Hollowell, J., Puddicombe, D., Redshaw, M., & Brocklehurst, P. (2012). Cost effectiveness of alternative planned places of birth in woman at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ (Clinical research ed.), 344, e2292.
Supporting healthy and normal physiologic childbirth: a consensus statement by the American College of Nurse-Midwives, Midwives Alliance of North America, and the National Association of Certified Professional Midwives. (2012). Journal of midwifery & women’s health, 57(5), 529–532. doi:10.1111/j.1542-2011.2012.00218.x
Transforming Maternity Care, Childbirth Connection, www.childbirthconnection.org/ 6. Maternity Care, Center for Healthcare Quality and Payment Reform, http://www.chqpr.org/maternitycare.html