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This version of
Midwifery in Texas: Safety, Regulation and Need
reflects, with only slight modification of format, research done by Kathy Rateliff
at the request of the Association of Texas Midwives (ATM). Kathy conducted her
research under contractual agreement with ATM, and this document is the result
of the compilation of her research. Plans are being made for a subsequent edition
of this document, which will feature expansion of content and standardization
of the annotation and citation schemes currently employed
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Midwifery
has always been legal in Texas, although not always regulated. Prior to 1989,
the law did not require much more than having midwives identify themselves by
registering with the county clerk. In 1989, the Midwifery Act was amended to include
mandatory basic and continuing education requirements which took effect in September,
1993. In 1993, The Midwifery Act was further amended to provide investigative
authority to the Midwifery Board. The most recent amendments occurred in September,
1997 when new rules were written to assist the Midwifery Board in implementing
the law through disciplinary actions which could include removal of documentation
and administrative penalties. 1
Safety
and Regulation
Birth and death information from the Texas Department
of Health for 1990 - 2000 indicate that birth with midwives in Texas has always
been a statistically safer option than birth with either a medical doctor or doctor
of osteopathy. State maternal mortality rates for all kinds of birth attendants
has been under 0.2/1000 since 1977.2 With midwifery assisted births, infant death
rates for 1990-2000 have never exceeded 3/1,000. Births performed by either an
MD or a DO have always been at least twice as high as the published rate for midwives.
The following table lists the infant mortality rate of midwives, CMNs,
MDs and DOs for 1990 - 2000.
Infant Mortality Rate by Attendant
Type 3
Rate per 1,000 live births
|
Year
|
Midwife
|
CNM
|
MD
|
DO
|
|
1990
|
3.0
|
3.0
|
7.6
|
7.7
|
|
1991
|
3.0
|
2.1
|
7.3
|
7.6
|
|
1992
|
2.3
|
2.8
|
7.5
|
7.7
|
|
1993
|
1.8
|
3.3
|
7.3
|
6.1
|
|
1994
|
1.7
|
4.5
|
6.8
|
6.4
|
|
1995
|
2.1
|
2.5
|
6.5
|
4.7
|
|
1996
|
1.1
|
3.1
|
6.3
|
4.0
|
|
1997
|
2.8
|
2.6
|
6.1
|
5.0
|
|
1998
|
1.7
|
2.4
|
5.7
|
6.5
|
|
1999
|
1.2
|
3.6
|
6.0
|
5.9
|
|
2000
|
0.3
|
1.9
|
5.5
|
4.7
|
As one can clearly tell,
except for 1991, midwives in Texas have had the lowest infant mortality rate of
any attendant type from 1990 - 2000. The source table for this information also
indicates that midwives in Texas had lower cesarean rates than all other provider
types, with rates typically under 2/1,000. Cesarean rates for both MDs and DOs
were consistently higher than 200/1,000 from 1991-2000.3
Regulation
of midwives and detailed rules for practice in the Midwifery Act does not account
for the comparably lower infant mortality rate. In fact, all levels of infant
mortality decreased some since 1990 and maternal mortality rates remained at 0.1/1000.2
Documentation and identification records of midwives from The Texas
Department of Health Midwifery Programs do, however, indicate that the numbers
of legally practicing midwives have steadily decreased since the passage of the
1989 Lay Midwifery Act. In 1989, there were 604 identified midwives practicing
in Texas,5 14,474 births attended by midwives and others, with almost 9000 of
these births taking place outside of the hospital.4 (Bureau of Vital Statistics
{BVS} Table 2 report for "Resident Births by Attendant and Place of Delivery
Texas, 1966-2000" does not differentiate between midwives and all other non-physician
attended birth or between home births and all other forms of out-of-hospital birth
sites. BVS statistics from 1990-2000 are broken down by attendant: Medical Doctor,
DO, CNM, Midwife, Other and Unknown.) In 1993 when new education and restriction
laws took effect, the number of midwives fell to 262,5 with 12,682 births attended
by midwives or others and 5,871 of these births occurred outside of the hospital.4
In 1997 when the most recent changes took effect, there were 217 licensed midwives,5
3,549 midwife assisted births,4 and 3,825 births were listed as out-of-hospital.3
The last available tabulated year for birth and death statistics from the BVS
is 2000 and indicates that the 182 licensed midwives5 assisted in 3,910 births3
and 3,360 births took place outside a hospital setting.4
Home birth
and midwife-assisted births in Texas are typical of safety results documented
across the world. Medical research for over a decade has concluded that home birth
safety statistics are at least as good, if not better than hospital birth statistics.
These statistics are true even when some studies looked at midwife-attended, out-of-hospital
births which could be classified more high risk than current midwifery standards
allow and those births which include unplanned out-of-hospital births.6, 7, 8
Current educational requirements for new midwives in Texas includes both
academic study from a variety of medical, midwifery and other authoritative sources
and clinical, hands-on, apprentice-modeled training. Certification in both CPR
and Neonatal Resuscitation (NNR) are also required in order to practice legally.
Standards for education and midwifery practice are consistent with those contained
in the MANA Core Competencies.9 Continued documentation as a midwife requires
annual continuing education hours, current CPR and NNR certification, and annual
application with fees submitted to the Texas Department of Health Midwifery Program.
The Midwifery Program is overseen by The Texas Midwifery Board.
The
Midwifery Board is currently working to revise the rules which govern the practice
of midwifery in Texas. The Rules Revision Committee has been involved in the process
by recommending standards which are consistent with current Texas law, exhibit
practice guidelines which have proven to insure safe midwife-assisted deliveries
in home and birth center, and which offer the consumer real choice in care. The
Rules Revision Committee consists of Midwifery Board members, practicing midwives
and CNMs, members of medical stake holder groups, and consumer members.
A
comparison of the current working draft of proposed midwifery rules from the Rules
Revision Committee to conclusions on safe midwifery practice in medical literature,
indicates that the proposed rules are consistent with standards proven safe for
planned home births attended by trained midwives.10, 11, 12, 13, 14, 15, 16 Those
evidence-based standards are also consistent with the definition of midwifery
care found in The Midwifery Act: "the practice by a midwife of giving the
necessary supervision, care, and advise to a woman during normal pregnancy, labor
and the postpartum period; conduction a normal delivery of a child; and providing
newborn care."17, 18
Need
A question often asked about home birth and/or midwifery as a birthing option
is, "With the current number of hospitals and obstetricians, is there a need
for out-of-hospital births and midwives?" The current available research
says, Yes!" and the reason are many.
Cost
Savings
Research demonstrates that midwifery is more cost-effective22
than the current medical model of hospital birth, even when transport to a hospital
during or following labor is needed. This includes birth in a free-standing birth
center19 or birthing at home.20 Cost for a home birth attended by a qualified
midwife in the US is generally 68% less than an uncomplicated vaginal delivery
in a hospital. Part of the reason for this cost-effectiveness is the lower incidence
of interventions and procedures during pregnancy, birth and the postpartum period
done to women and their newborns.20
Estimates of annual savings to
insurance companies, government medical programs, and consumers ranges in the
hundreds of billions of dollars. Most importantly, this savings could come with
no decrease in safety in maternal or neonatal mortality or morbidity. Much of
this savings would come by eliminating procedures with little or no proven ability
to improve safety and by utilizing midwives more.20, 21, 22 In fact, much of the
technology that would be limited or eliminated would be done by following guidelines
published in Guide to Effective Care in Pregnancy and Childbirth23 and the World
Health Organization's Care in Normal Birth: a Practical Guide.24
Evidence-Based Practice
A Guide to Effective Care in Pregnancy and Childbirth is a compilation of the
best international evidence-based research regarding the care of pregnant women
and their babies. The Synopsis contains six tables classifying basic elements
of care during pregnancy and childbirth according to their effectiveness and potential
to benefit or harm. The six tables are:
Table 1: Beneficial
forms of care
Table 2: Forms of care likely to be beneficial
Table 3:
Forms of care with a trade-off between beneficial and adverse effects
Table
4: Forms of care of unknown effectiveness
Table 5: Forms of care unlikely
to be beneficial
Table 6: Forms of care likely to be ineffective or harmful
It
is interesting to note that many of the elements which carry the best clinical
evidence of efficacy and benefit are also components of the Midwifery Model of
Care.25, 26, 27, 28, 29 Some components of the Midwifery Model of Care which are
also included in either Table 1 or 2 in the Guide to Effective Care include: seeing
pregnancy as a normal rather than a medical condition, respecting the right of
a woman to choose her birth companions, respecting a woman's right to choose her
place of birth, informed consent and refusal in all matters, nutritional education,
healthy life-style changes when needed (stop smoking, alcohol moderation, appropriate
treatments for medical problems that do not harm the baby), support of the mother
(physically, emotionally, psychologically), social support provided to the mother/family,
midwifery care for low risk women, continuity of care, prenatal education, accurate
risk assessment, competent and individual care based on each woman's need, interventions
only when there is a demonstrated need, external cephalic versions for breech
or transverse lie at term, continuous support during labor, freedom of movement
and position choice in labor and birth, positional changes for fetal distress
in labor, use of non-medicinal methods to deal with pain in labor (positional
changes, counter-pressure, superficial heat or cold, touch and massage, focus
and distraction, music and audio-analgesia, etc.), delivery at term, vaginal delivery
whenever possible, perineal guarding, VBAC if previous cesarean was low transverse,
birth attendant with neonatal resuscitation skills, breastfeeding support and
education, early mother-infant contact, rooming-in, support for postpartum depression,
and grief support for parents who loose a baby.
The
Right to Choose
The September 1999 version of the Midwifery Act
states the following: "The legislature finds: 1) a parent has the responsibility
and right to give birth where and with whom the parent chooses."30 Further,
the Royal College of Midwives positional paper on Home birth states: "Childbearing
women are nearly always competent adults and therefore have every right to decide
to give birth in their own homes (the exceptions to this are women prisoners and
women who have been declared by the courts to lack the mental capacity to consent
to medical treatment) (RCM, 1998)."12 Both of these statements highlight
the importance of individual choice in pregnancy and childbirth.
Indeed,
evidence-based research concludes that self-determination may positively or negatively
affect health and the effectiveness of treatment.31 "Choice itself (allowing
women to choose home or hospital birth) may influence levels of anxiety and apprehension
and thereby also the outcome of maternity care."32 Therefore, respect for
a woman's choice in birth location and attendant may be crucial in helping her
to have the safest birth possible.
Research by Davies et al entitled "Prospective
regional study of planned home births spotlights the issue of the woman's right
to choose and attitude of other caregivers when she makes a choice contrary to
the one they want.33 The study included 251 women who requested home birth in
1993. "Two thirds of the women (in the study) thought they had not been offered
any option about place of birth."
"Some women seem to believe
that it is mandatory to have a general practitioner's approval before they can
proceed with home delivery, but only one third of women who commented had been
given any option about place of birth by their general practitioner. One woman
tried 12 different doctors and could not find one prepared to provide intrapartum
care; she continued to search even though she had already had one home birth without
a general practitioner present."
"Women whose formal requests
for a home birth were noted had obstacles placed in their way. Though women wanted
the support of their general practitioner, only a minority had a doctor who thought
their request was appropriate. For most women it was never a proffered option."33
Table 3 from this study looks at the reasons women in this study chose
a home birth. Reasons prior to delivery included: more in control, prefer to be
at home, more natural, partner more involved, less intervention, less stress for
baby, no need to leave other children, safer at home, and no transport worries.
Reasons expressed after delivery included: relaxed, in control, natural, non-clinical,
peaceful, calm, private, joyful celebration, confident, welcome for baby at home,
and safer at home.
A home birth study from Scotland also reported some
interesting comments regarding choice.
"The proportion
of home births in Scotland in 1994 was small (0.7%), but for those mothers the
provision of this service was very important. Despite some difficulty in achieving
home birth and despite pockets of professional antagonism, those mothers who achieved
their wishes were very satisfied with the experience. The maternal outcomes for
the home birth group were as good, if not better than their hospital birth counterparts.
The group transferred to hospital had slightly less good outcomes than the mothers
who were able to stay at home, but as 65% of them achieved a normal birth it would
appear that the midwives erred on the side of caution. The neonatal outcomes were
good on the whole, but the lower birth weight and increased resuscitation in the
transferred group was a reflection of the reasons for transfer. Overall, all the
mothers, irrespective of the place of birth, expressed satisfaction with their
care, but it was more pronounced in those whose choice had been home birth and
who had been able to have a home birth." 34
A small 1992
study by Wright comparing 22 births at home to 23 hospital births also focuses
on choice:
"All mothers in this study were multiparous
except one in each group. All the pregnancies were wanted and all the women had
help at home. Many women felt that they had had no choice about the place of birth,
and had merely complied with what they saw as the existing system of hospital
births. There had been no discussion on the subject with health care workers.
While those having hospital deliveries talked about perceived risks and safety,
those who had home births identified specific reasons for their choice and retrospectively
emphasized the fulfilling and satisfying process. Both groups felt their choice
had been right for them. For the majority delivering at home, their decision had
been determined by a previous unexpected home birth which had been a good experience.
The perceived lack of choice raises important questions about the way in which
information is given to women in pregnancy." 35
The British
Medical Journal Clinical review series on the ABC of ...includes a review entitled
"ABC of labour care Place of Birth. Objectives of good labour care include
: providing a safe outcome with a minimum of avoidable complication and making
birth a satisfying experience. Reasons for choosing home birth were noted as:
avoidance of unnecessary intervention 31%; more relaxed and in control in familiar
surroundings 25%; previous home birth 11%; wish to be in a familiar setting to
aid relaxation 10%; fear of hospital 10%; and a continuing relationship with the
midwife 4%. Reasons for choosing a hospital setting were safety 84% and previous
hospital birth 6%. A definition of "Women centred care: states, "In
whatever setting birth takes place, every effort should be made to ensure that
the woman is made to feel physically and psychologically as comfortable as possible.
She should perceive herself to be in control of what is happening and be able
to make decisions about her care, having had full discussions with the professionals
involved." 36
Demographic patterns of women who choose home birth
are typically older than the average childbearing woman, having higher parity,
more likely to be married, predominately white, middle class, have a healthier
lifestyle as evidenced by smaller percentages of smokers and drinkers, more likely
to breastfeed and do so for longer periods of time, more motivated to take an
active role in their care and more likely to start prenatal care later. One US
study population of home birth mothers had less formal education 37, but other
US study populations showed mothers have more formal education or more equally
split 38, 39. 40, 41, 42 which is more typical of international home birth populations.
43
Women who have had or attempted a home birth are more likely to
say that they were happy with the experience and would choose a home birth in
subsequent pregnancies. 44 This fact creates a two-fold concern in Texas. First,
with a significant decrease in the number of licensed midwives available to
attend births, women may choose to birth unassisted if they cannot find a legal
attendant. Secondly, if home birth lost it's legal status or severely restricted
the number of women who qualify as low risk, a significant number of women would
still choose to birth at home and might choose to do so unattended. 6, 7, 14,
16, 33, 37 These two factors could lead to less safe conditions at home births.
It is important to maintain a level of safety by practicing at a level
determined safe by evidence-based research. It is also important to encourage
and support a population of qualified birth attendants who are experienced in
home birth conditions so that those women who choose to birth at home can do so
safely.
A Shortage of Attendants
A national news story during the week of July 21-27, 2002 reported that many obstetricians
are leaving the field due to the high cost of malpractice insurance, and many
Family Practice and General Practitioner Doctors have stopped doing births for
the same reason . The story noted that malpractice premiums for OBs have increased
by 500% or more over the last 10 years. Additionally, the last ten years has witnessed
the closing of many small hospitals and medical practices for economic reasons.
As noted earlier, the number of legal midwives in Texas has also declined.
Support of midwifery as a reasonable alternative for low risk women would
help to insure that all women who need prenatal care can find care. Requiring
insurance companies, HMOs, PPOs, and Medicaid to cover midwifery assisted births
at birth centers and at home for low risk women would allow more women who desire
this option to afford it. Extending payment reimbursement or coverage would not
increase medical birth costs; it would actually lower the annual costs now covered
due to the high numbers of doctor-attended hospital births to low risk women.
Increase
in Options
July 5, 2001, The New England Journal of Medicine published
an article on the safety of VBACs. 45 This article led many hospitals to issue
policies banning VBACs in their facility. Despite several articles refuting the
conclusions of study, 46, 47 VBACs continue to be out of reach of many women.
More women are turning to midwives and out-of-hospital births to achieve the VBAC
they desire. VBACs are more likely to succeed and less dangerous at home because
labor induction, especially with prostaglandins, is not recommended or desired
in a home setting.
Additional options sought by women but not found in many
hospitals are water births, freedom to ambulate and choose labor and birth positions,
freedom to eat and drink in labor, freedom to invite whomever they choose to attend
the birth, freedom from having the newborn removed from the presence of the mother
in the absence of medical need, freedom from unwanted strangers intruding during
the birth, freedom to video record the birth and freedom from unwanted and unneeded
medical interventions. Midwives in a home birth setting can and often do easily
accommodate these options, creating a more satisfactory birth.
The
Journal of Health Politics, Policy and Law addressed the issue of home birth in
December, 1994. The following comments seemed to be most pertinent to this issue:
"Reviewing the full spectrum of literature from the United
States and abroad, we present a Constitutional medical-legal analysis of whether
home birth with direct-entry midwives is in fact a safe alternative to physician-attended
hospital births, and whether there is a legal basis for allowing alternative health
policy choices in such an important yet personal family matter as childbirth.
The literature shows that low- to moderate-risk home births attended by direct-entry
midwives are at least as safe as hospital births attended by either physicians
or midwives. The policy ramifications include important changes in state regulation
of medical and alternative health personnel, the allowance of the home as a medically
acceptable and legal birth setting, and reimbursement of this lower-cost option
through private and public health insurers."48
Conclusion
Home birth and midwife-assisted deliveries are here to stay. Multiple medical
research studies affirm the safety of these choices for low risk women. The evidence-based
care commonly used in most midwifery practices increase the safety factor and
often increase the satisfaction women have with their birth. Current education
requirements and both current and proposed midwifery rules in Texas provide a
foundation that will ensure safe midwifery care for women and their babies.
Women who choose midwifery care have the right to choose where and with
whom they deliver. They also have the right to full knowledge of benefits and
risks of available options in pregnancy, childbirth and parenting and the right
to determine what options they will consent to or refuse. Because women who choose
home birth are generally more motivated to take an active part in their care,
more educated regarding options, and healthier than most women choosing a hospital
birth, their pregnancies and birth generally remain low risk.
Future
needs include: required coverage and/or reimbursement for midwifery care in or
out of hospital, education of pregnant women regarding the availability of midwife-assisted
birthing and home birth, better cooperation and collaboration between midwives
and the medical community when women need transfer of care or medical consults,
and support of the midwifery community as a valid option for low risk women.
References
1.
Texas Midwifery Basic Information and Instructor Manual; Texas Department of Health,
1998 edition, Section 1, "History of Midwifery."
2. "Table
5: Resident Infant, Maternal and Fetal Deaths, Texas, 1966 - 2000"; Texas
Department of Health - Bureau of Vital Statistics Annual Report, 2002.
3.
"Birth, Infant Death, and C-Section Births, by Attendant Type Occurrence
in Texas 1990-2000," Texas Department of Health Bureau of Vital Statistics
Annual Report, 2002.
4. "Table 2: Resident Births by Attendant and
Place of Delivery Texas, 1966 - 2000"; Texas Department of Health - Bureau
of Vital Statistics Annual Report, 2002.
5. Correspondence from Texas Department
of Health Midwifery Program Report, 5/2/02.
6. Bastian H, Keirse MJNC, Lancaster
PAL; "Perinatal death associated with planned home birth in Australia: population
based study" BMJ, vol 317, no 7155, 8 August 1998, pp 384-388.
7. Mehl-Madrona
L, Mehl-Madrona M; Physician- and midwife-attended home births. Effects of breech,
twin, and post-dates outcome data on mortality rates Journal of Nurse-Midwifery
, vol 42, no 2, March/April 1997, pp 91-98.
8. Northern Region Perinatal
Mortality Survey Coordinating Group; Collaborative survey of perinatal loss in
planned and unplanned home births; BMJ , vol 313, no 7068, 23 November 1996, pp
1306-1309.
9. "MANA Core Competencies for Basic Midwifery Practice",
Midwives Alliance of North America, Revised 6/91.
10. "Working draft
of proposed new rules," Texas Midwifery Board and Rules Revision Committee
Minutes, 3/18/02 draft edition.
11. Janssen PA, Holt VL, Myers SJ; Licensed
midwife-attended, out-of-hospital births in Washington State: are they safe? Birth
, vol 21, no 3, September 1994, pp 141-148.
12. Royal College of Midwives
Position Paper 25, Home birth; London: Royal College of Midwives , January 2002.
13.
Olsen O, Jewell MD; Home versus hospital birth. (Date of most recent substantive
amendment: 20 April 1998) In: The Cochrane Library. Oxford: Update Software ,
issue 1, 2002.
14. Olsen O; Meta-analysis of the safety of home birth; Birth
, vol 24, no 1, March 1997, pp 4-13
15. Campbell R; Macfarlane A Where
to be born? The debate and the evidence; Oxford: National Perinatal Epidemiology
Unit , 1994. 2nd ed. 176p.
16. Anderson RE, Murphy PA; Outcomes of 11,788
planned home births attended by certified nurse-midwives. A retrospective descriptive
study; Journal of Nurse-Midwifery , vol 40, no 6, Nov/Dec 1995, pp 483-492.
17.
Texas Midwifery Basic Information and Instructor Manual; Texas Department of Health,
1998 edition, Section 1.1, "What is Midwifery."
18. Texas Occupations
Code, Title 3. Health Professions, Subtitle C. Other Pofessions Performing Medical
Procedures; Chapter 203. Midwives; Texas Midwifery Action Subchapter A, Section
203.002 Definitions (items 7 a,b, & c); Ammended 9/1/99.
19. Walker
PH, Stone PW; "Exploring cost and quality: community-based versus traditional
hospital delivery systems;" Journal of Health Care Finance, 1996; 23(1),
p 23-47.
20. Anderson RE, Anderson DA; The Cost-Effectiveness of Home Birth;
Journal of Nurse-Midwifery, Vol 44, no 1, Jan/Feb 1999. p. 30-35.
21. Wagner
M; "Technology in Birth - First Do No Harm; Midwifery Today, 2000 - article
reprint online at: www.midwiferytoday.com/articles/technologyinbirth.asp
22.
Schlenzka P, Safety of Alternative Approaches to Childbirth; Unpublished dissertation,
Palo Alto, CA; Stanford University, 1999.
23. Enkin M, Keirse MJNC, Neilson
J, Crowther C, Duley L, Hodnett E, and Hofneyer J; A Guide to Effecitve Care in
Pregnancy and Childbirth, 3rd Edition; Oxford Univeristy Press, 2000.
24.
World Health Organization. Care in Normal Birth: a practical guide. Geneva, 1996.
25.
Frye A; Holistic Midwifery: a comprehensive textbook for Midwives in Homebirth
Practice, Vol. 1 Care During Pregnancy; Labrys Press, Portland OR; 1998 revised
edition, pp. 14-15.
26. Stewart D; The Five Standards for Safe Childbearing;
Napsac Reproductions, Marble Hill MO, 1981.
27. Jones C; Childbirth Choices
Today: Everything you need to know to plan a safe and rewarding birth; Carol Publishing
Group, NY, 1995, pp. 120 - 144.
28. Legal Conclusions in the Matter of the
Accussation Against Alison Osborn before the Division of Licensing Medical Board
of CA, Dept. of Consumer Affairs; 8/25/99
29. Rooks EP; Evidence-Based Practice
and It's Application to Childbirth Care for Low-Risk Women; Journal of Nurse-Midwifery,
Vol 44, no 4, July/Aug 1999, pp 355-369.
30. Texas Occupations Code, Title
3. Health Professions, Subtitle C. Other Pofessions Performing Medical Procedures;
Chapter 203. Midwives; Texas Midwifery Action Subchapter A, Section 203.003. Findings
(1); Ammended 9/1/99.
31. Crandon AJ; Maternal anxiety and obstetric complications,
Journal of Psychosomatic Research, 1979; 23; 109-11.
32. Wiegers TA, Keirse
MJNC, van der Zee J et al; Outcome of planned home and planned hospital births
in low risk pregnancies: prospective study in midwifery practices in the Netherlands
BMJ , vol 313, no 7068, 23 November 1996, pp 1309-1313.
33. Davies J; Hey
E; Reid W; and others Prospective regional study of planned home births; BMJ,
vol 313, no 7068, 23 November 1996, pp 1302-1306.
34. Murphy-Black T , Pinkerton
K; STUDY NUMBER 0448, MIRIAD data base; Home births in Scotland ; 01/10/93 - 01/04/95
Scottish Office Home and Health Department (CRAG) (External)
35. Wright
C: Birth - hospital or home? MIRIAD study no. 0226; 01/09/92; Hinchingbrooke Hospital.
36.
Zander L and Chamberlain G; ABC of labour care Place of Birth; BMJ Mar 13, 1999;
Vol 318; pp 721-723.
37. Declercq ER, Paine LL, Winter MR; Home Birth in
the United States, 1989-1992 A Longitudinal Descrptive Report of National Birth
Certificate Data; Journal of Nurse Midwifery, Vol 40, no 6, Nov/Dec 1995, pp 474-482.
38.
Anderson R and Greener D; A Descriptive Analysis of Home Births Attended by CNMs
in Two Nurse-Midwifery Services; Journal of Nurse Midwifery, Vol 36, no 2, Mar/Apr
1991, pp 95-102.
39. Murphy PA and Feinland JB; Perienal Outcomes in a Home
Birth Setting; Birth 25:4, Dec 1998, pp 226-234.
40. Murphy PA and Fullerton
J; Outcomes of Intended Home Births in Nurse-Midwifery Practice: A Prospective
Descriptive Study; Obstetrics and Gynecology Vol 92, no 3, Sept 1998; pp 461-469
41.
Durand MA; The Safety of Home Birth; The Farm Study; American Journal of Public
Health Vol 82, no 3 Mar 1992, pp 450-453.
42. Jackson ME and Bailes AJ;
Home Birth with Certified Nurse-Midwife Attendants in the United States an Overview;
Journal of Nurse Midwifery, Vol 40, no 6, Nov/Dec 1995, pp 493-503.
43.
Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, and others; Home versus hospital
deliveries: follow up study of matched pairs for procedures and outcome BMJ ,
vol 313, no 7068, 23 November 1996, pp 1313-1318.
44. Waldenstrom U, Turnbull
D; A systematic review comparing continuity of midwifery care with standard maternity
services, British Journal of Obstetrics and Gymaecology 1998, Vol 105, no 11,
pp. 1160-1170.
45. Lyndon-RochelleM, Holt VL, Easterling TR and Martin DP;
Risk of Uterine Rupture During Labor Among Women With a Prior Cesarean Delivery;
NEJM Vol 345, no 1 7/5/2001, p.3-8.
46. Greene MF; Vaginal Delivery After
Cesarean Section - Is the Risk Acceptable editorial; NEJM, Vol 345, no 1 7/5/2001,
pp 54-55.
47. MacCorkle J; Standing up to the VBAC-lash: a critique of the
New England Journal of Medicine VBAC study and implications for the future of
the medical model of childbirth; Sept 2001; http://maccorkl.home.sprynet.com/VBAClash.htm
48.
Hafner-Eaton C, Pearce LK; Birth choices, the law, and medicine: balancing individual
freedoms and protection of the public's health Journal of Health Politics, Policy
and Law , vol 19, no 4, December 1994, pp 813-835.
Additional
Sources Not Directly Cited Above
49. Blais R, Lambert J, MaheuxB, Loiselle
J, Gauthier N and Framarin A; Controversies in Maternity Care: Where do Physicians,
Nurses and Midwives Stand? Birth, 21:2 June, 1994, pp 63-70.
50. Beesley
K; Guest Editorial Home Birth The delivery of Safe and Satisfying Care to Women
and Their Families; Journal of Nurse-Midwifery, Vol 40, no 6, Nov/Dec 1995, pp
463-465.
51. CIMS; The Mother-Friendly Childbirth Initiative; July 1996;
http://www.health/net/cims.
52. Ford C, Iliffe S, Franklin O; Outcome of
planned home births in an inner city practice; BMJ Vol303, 12/14/91; pp 1517-1519.
53.
Tyson H; Outcomes of 1001 Midwife-Attended Home Births in Toronto, 1983-1988;
Birth 18:1, March 1991, pp 14-19.
54. Janssen PA, Lee SK, Ryan EM et al;
Outcomes of planned home births versus planned hospital births after regulation
of midwifery in British Columbia; Canadian Medical Association Journal, Vol 166,
no 3, Feb 5, 2002; pp 315-323
55. Goer H; The Thinking Woman's Guide to
a Better Birth; Penguin Putnam Inc, NY; 1999.
56. Chamberlain G; Wraight
A; Crowley P; editors Home births: the report of the 1994 confidential enquiry
by the National Birthday Trust Fund Carnforth: Parthenon Publishing Group Ltd
, 1997.
57. National Childbirth Trust Home birth information sheet London:
National Childbirth Trust , [2001]. 2 page Information sheet that answers questions
parents may have about the availability and safety of a home birth. (RGW) Available
from:NCT Maternity Sales, 239 Shawbridge Street, Glasgow, G43 1QN, Scotland. Tel:
0141-636 0600; Fax: 0141-636 0606 E-mail: sales@nctms.co.uk; Website: www.nctpregnancyandbabycare.com
