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Comment and Controversy

Evidence points to safety of home birth

November 2009 · Vol. 21, No. 11
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As experts in “normal” birth and home birth, we are concerned about the disregard for fact and evidence that is apparent in Dr. Tracy’s article, and we feel it is our duty to clarify the incorrect statements, offering published scientific evidence to back up our assertions.

We would like to make three main points:

  1. Important data were overlooked
    Numerous scientific articles published over the past 20 years have documented the safety of home birth. One of the most notable scientific articles on the subject was authored by de Jonge and colleagues.1 It includes retrospective data on more than 500,000 women and found no difference in the rate of perinatal mortality or morbidity between planned home birth and planned hospital birth.
  2. CPM credential requires testing, training
    In regard to the training required to attain the Certified Professional Midwife (CPM) designation, it is necessary to pass a professional licensing exam in addition to undergoing training and credentialing to offer expert and evidence-based out-of-hospital care. The CPM credential requires the midwife to master clinical and didactic skills, demonstrate the acquisition of knowledge and skills, and perform competently under supervision.
  3. ACOG should work for women’s empowerment, too
    Dr. Tracy says that women who choose home birth “because of impassioned rhetoric about empowerment and choice may be deeply disappointed if it goes awry and transfer to the hospital is needed.” According to Johnson and Daviss,2 only 12% of women who planned a home birth had to be transferred to a hospital. This leaves 88% of women impassioned and empowered by their safe choice. It also is worth noting that women who transfer to the hospital from a planned home birth in the United States often face a hostile reception from hospital personnel.3,4 Perhaps their disappointment emerges from this disrespectful treatment. We are also curious as to why empowerment and choice are not considered indicators of quality of care for a professional organization—ACOG—that works to “serve as a strong advocate for quality health care for women.”

Geradine Simkins, RN, CNM, MSN
Maria Iorillo, CPM
Christy Tashjian, CPM
Angy Nixon, CNM, MSN
Audra Phillips, CPM
Pam Dyer Stewart, CPM
Regina Willette, CM
Tamara Taitt, DEM, PhDc
Sherry DeVries, CPM, CNM
Elizabeth Moore, CPM
Colleen Donovan-Batson, CNM
Dinah Warranch, CNM
Cristina Alonso, DEM
Michelle Peixnho, CPM

Midwives Alliance of North America

Follow the link for Dr. Tracy’s response.


1. de Jonge A, van der Goes BY, Ravelli ACJ, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG. 2009;116:1177-1184.

2. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416.-

3. Cheyney M, Everson C. Narratives of risk: speaking across the hospital/homebirth divide. Anthropology News. 2009;50(3):7-8.

4. Davis-Floyd R. Home-birth emergencies in the US and Mexico: the trouble with transport. Social Science & Medicine. 2009;56(9):1911-1931.

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