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For Immediate Release 
CIMS Responds to the Publication of an Extremely Skewed Study on theSafety of Homebirth
Raleigh, NC (July 9, 2010)
‐
The Coalition for Improving Maternity Services (CIMS) is outragedthat the publishers of the
 American Journal of Obstetrics and Gynecology 
(AJOG) accepted apoorly designed and methodologically unsound study in which authors concluded there is a 3‐fold increase in neonatal mortality in planned home births compared with planned hospitalbirth.
 
"In our analysis of multiple studies from countries worldwide," stated CIMS Chair MichelleKendell, MBA, AAHCC, "CIMS found that the authors of the study included confounding data,such as outdated and low‐quality studies, low‐risk and high‐risk mothers, babies born preterm,babies unintentionally born at home, births attended by unqualified providers, and data frombirth certificates that researchers have found to be notoriously inaccurate." Although the authors acknowledged that most of the articlesreviewed had similar outcomes of low neonatal mortality, they based their conclusion on statistics drawn from questionable andpoor quality studies. Furthermore, the study's lead investigator Joseph R. Wax, MD, and his co‐authors inexplicablyeliminated the only high‐quality study of planned homebirths in the U.S. that showed excellenthealth outcomes for infants and their mothers when attended by certified professionalmidwives. (
 Johnson & Daviss BMJ 2005
). In a press release, theAmerican College of Nurse‐Midwives
 
, a CIMS Organizational Member,reported, "the authors' conclusion differs significantly from findings of many recent high‐quality studies on home birth outcomes which found no significant differences in perinataloutcomes between planned home and planned hospital births." Other research conducted by theCIMS Expert Work Groupfound that planned home births witha qualified care provider resulted in similar, not greater, perinatal mortality rates comparedwith a similar low‐risk population of women having hospital births, despite lower interventionrates, including electronic fetal monitoring, use of IVs, pain medication, instrumentaldeliveries, and cesarean sections. Lamaze International, a CIMS Organizational Member, also questioned the study's conclusion.Amy Romano, MSN, CNM, researcher and contributor on Lamaze International'sScience &Sensibilityblog, wrote, "high quality studies, conducted in low‐risk women in integratedmaternity care systems, find no excess risk for babies and significant benefits for mothers."TheCenters for Disease Control(CDC) reports that babies born at home are less likely to beborn preterm and low birth weight compared to babies born in the hospital. 
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 Mary Lawlor, CPM, president of theNational Association of Certified Professional Midwives, aCIMS Organizational Member, stated the study "is far from the high‐quality rigorous review thathealth care providers and the public expect." Also, commenting on the study, Geradine Simkins, CNM, MSN, president of theMidwivesAlliance of North America, a CIMS Organizational Member, stated, "The American public,particularly women in the childbearing years and those who care for them, have a right to highquality research on childbirth. Research literature should not be used to cause undue alarm orlimit a woman's choice regarding care providers, including skilled midwives, and place of birth." The study at the heart of this debate,"Maternal and newborn outcomes in planned home birthvs planned hospital births: a metaanalysis"
 
, originally intended for print publication in theSeptember 2010 issue of the
 American Journal of Obstetrics and Gynecology 
(AJOG), waspublished online on July 1. Researchers and critics suspect that the early release was politicallymotivated to discredit midwives who attend the majority of home births in the U.S. and todiscourage legislators from passing increasingly pro‐midwife state legislation such as New YorkState'sMidwifery Modernization Act(Bill S5007a/A8117b), which passed on June 28 withoverwhelming bipartisan support, providing autonomous practice for all licensed midwivesworking in all settings. CIMS' advisor, Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institutein Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia believes this is "an unabashed attempt to have poor science cover‐unsuccessfully‐a political agenda. I am very surprised that the [Journal] would publish it, letalone call it 'Editors Choice'." According to the CDC, the number of women opting to have their babies at home has beenincreasing since 1990 and rose by 5% in 2005 and remained steady in 2006. This is significantbecause it marked the first time in 14 years that the percentage of out‐of‐hospital birthsincreased in the U.S. In 2006 there were 4.2 million births in the U.S., of which approximately25,000 (.59%) were home births. About 61% of home births were attended by midwives.Among midwife‐delivered home births, one‐fourth (27%) were delivered by certified nurse‐midwives, and nearly three‐fourths (73%) were delivered by other professional midwives. "Women choose to have a home birth for many reasons," states Nicette Jukelevics, chair of theCIMS Coalition Building Committee. "For financial, cultural or religions concerns, lack of transportation in rural areas, or to give birth in a supportive, low‐intervention, familiarenvironment. Other countries like Great Britain, Ireland, Canada, and the Netherlands supportwomen's choice for home birth. The unsubstantiated controversy against planned homebirthwith a qualified provider has been with us for many decades. It's time that women in the U.S.have the same right and opportunity to give birth as they choose." The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and nationalorganizationswith concern for the care and wellbeing of mothers, babies, and families. Ourmission is to promote a wellness model of maternity care that will improve birth outcomes andsubstantially reduce costs. This evidence‐based mother‐, baby‐, and family‐friendly modelfocuses on prevention and wellness as the alternatives to high‐cost screening, diagnosis, andtreatment programs. Media Inquiries: Denna Suko (919) 863‐9482,dsuko@motherfriendly.org
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