Anderson, Rondi E., Aikins Murphy, Patricia. Outcomes of 11,788 Planned Home Births Attended by Certified Nurse-Midwives, A Retrospective Descriptive Study. Journal of Nurse-Midwifery, Vol. 10, No. 6, Nov./Dec., 1995

This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNM's) from 1987 to 1991. A retrospective survey was used to obtain information about the outcomes of intended hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery home birth practices). It is estimated that 60-70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000 including known third trimester demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartum transfer rate for standard risk-assesment criteria, only delivered low risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned Home birth with qualified care providers can be a safe alternative for health lower risk women.

Aikins Murphy, Patricia & Fullerton, Judith. Outcomes of Intended Home Births in Nurse-Midwifery Practice: A Prospective Descriptive Study. Journal of Nurse-Midwifery, Vol. 92, No. 3, Sept . 1998.

Results: Of 1404 enrolled women intending home births, 6% miscarried, terminated the pregnancy or changed plans. Another 7.4% became ineligible for home birth prior to the onset of labor at term due to the development of perinatal problems and were referred for planned hospital birth. Of those women beginning labor with the intention of delivering at home, 102 (8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were transferred to the hospital after delivery, and 14 infants (1.1%) were transferred after birth. Overall intrapartal fetal and neonatal mortality for women delivering at home, intrapartal fetal and neonatal mortality was 1.8 per 1,000. 
Conclusion: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage.

MacDorman, Marian & Singh, Gopal, Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA. Journal of Epidemiol Community Health, Vol. 52, 1998.

Main Results: After controlling for social and medical risk factors, the risk of experiencing an infant death wad 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birth weight infant was 31% lower. Mean birth weight was 37 grams heavier for the certified nurse midwife attended than for the physician births.
Conclusions: National data support the findings of previous local studies that certified nurse-midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labor and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women.