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England's Birthplace Study and Implications for the United States

Landmark study supports women's choice in birth setting and the value of midwifery care

For Immediate Release 
November 29, 2011

Contact: Melissa Garvey
Office: (240) 485-1826
E-mail: [email protected]

Silver Spring, MD - As more US women consider giving birth in out-of-hospital settings, there is an ever-growing need for objective information to guide women's choices and improve the safety of US maternity care systems. On Friday, the British Medical Journal released a breakthrough study of nearly 65,000 healthy women with low-risk pregnancies. The prospective study compared the safety and cost of birth in four settings: obstetric-led units (similar to US hospitals), alongside midwifery-led units (similar to US in-hospital birth centers), freestanding midwifery-led units (similar to US freestanding birth centers), and the home.

American College of Nurse-Midwives President Holly Powell Kennedy, CNM, PhD, notes the importance of this research. "The Birthplace Study represents one of the few countrywide efforts to examine mother and newborn outcomes of births based on which site the mothers planned to give birth in. This prospective study thoroughly examined multiple factors which will help the United States consider future systems of care in the face of changing maternity care capacities and support a range of services being available."

Regardless of birth setting, poor outcomes were rare. Of the almost 65,000 low-risk births, there were only 250 births where the baby had a poor outcome, or 4.3 events per 1000 births. This is consistent with birth outcomes for low risk women in general and supports the opportunity for women to make informed choices about the site and type of health care provider they desire.

Major study findings relevant to the United States include:

  • Midwifery care is safe and associated with less medical intervention in labor, such as cesarean delivery, forceps delivery, episiotomy, and blood transfusion compared to non-midwifery care.
  • Costs are lower for births planned at home and in midwifery units compared to births in obstetric units. The costs of the more time-intensive midwifery model of care are outweighed by savings in less interventions (such as cesarean section).
  • Women having a second or subsequent baby had excellent outcomes in all settings, requiring fewer transfers from their planned place of birth. First-time mothers who gave birth at home had a slightly increased risk of a poor outcome for their baby compared to the hospital setting and had higher rates of transfer from their planned site of birth.
  • Women who require transfer from out-of-hospital settings during labor are best supported when systems include excellent communication and swift transport.

The Birthplace Study highlights current problems in the United States related to our maternity care system-in particular our lack of an integrated system of care between home and hospital and our underuse of midwifery care across all birth settings. These issues were recently addressed at a historic Home Birth Consensus Summit in October 2011, which resulted in nine recommendations for policy, research, and practice changes on a national scale.

"We have appalling maternal-child health outcomes compared to other high-resource countries," says Kennedy, "and one in three women will have her baby delivered by major surgery, which is associated with short- and long-term complications. It is time for us to redesign our maternity health systems and distribute best models of care in order to meet the needs of all women and their infants." 


For more information, please contact Melissa Garvey, ACNM Communications Manager at (240) 485-1826 or via e-mail at [email protected].

The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives and certified midwives in the United States. With roots dating to 1929, ACNM is one of the oldest women's health care organizations in the United States. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and liaisons with state and federal agencies and members of Congress. More information about ACNM can be found at www.midwife.org.

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