Outcomes and Risk: What the Data Really Shows

Neonatal Death Rates: Elevated Risk in Home Births

Multiple studies have found that planned home births, particularly those attended by Certified Professional Midwives (CPMs), are associated with significantly higher rates of neonatal death compared to hospital births attended by Certified Nurse-Midwives (CNMs) or physicians.

• A study analyzing CDC data from 2010–2017 found that neonatal mortality rates were 3.27 per 10,000 live births for hospital births attended by CNMs, compared to 12.44 per 10,000 for planned home births attended by direct-entry midwives—a relative risk of 3.8.¹

• Another study reported a total neonatal mortality rate of 2.19 per 1,000 for home-birthed infants, compared to 0.38 per 1,000 for hospital-born infants.³

These findings confirm that home births with CPMs carry 3–6 times the risk of neonatal death compared to births attended by CNMs in hospitals.

Risky Births, No Safeguards

CPMs frequently attend high-risk births in out-of-hospital settings that would require surgery or intensive monitoring in a hospital. These include:

• Vaginal Birth After Cesarean (VBAC)

• Breech presentations

• Twin deliveries

• Postdates (>42 weeks)

CPMs do not have surgical access, anesthesia services, resuscitation teams, or NICU backup. As a result, complications that could be managed in a hospital may become fatal at home.

Transfer Delays and Emergency Response Failures

Documented investigations, including USA TODAY's “Failure to Deliver,” describe multiple cases of CPMs delaying or avoiding hospital transfer, even in life-threatening situations. This is often due to:

• Lack of hospital privileges

• Fear of losing the case or income

• No established transfer protocols

When a midwife is not part of the health system, emergency care may arrive too late to prevent harm.

Incomplete and Misleading Reporting

Unlike licensed health professionals, CPMs are often not required to report adverse outcomes, including:

• Neonatal deaths

• Fetal losses

• Emergency transfers

• Maternal injuries

In many states, outcome reporting is voluntary, incomplete, or self-submitted, making it difficult for the public, researchers, or lawmakers to understand the full scope of harm.

MANA's Own Data: Breech Birth at Home Carries Unacceptable Risk

In the largest CPM-led home birth dataset ever published, the Midwives Alliance of North America (MANA) reported outcomes from over 16,000 planned home births between 2004 and 2009. While advocates hoped the data would confirm safety, it revealed alarming risks—especially for high-risk scenarios like breech presentations.

The neonatal death rate for planned out-of-hospital breech births in the MANA dataset was
10.7 per 1,000—more than 25 times higher than for head-down (vertex) births in the same data.⁶

That means 1 in 93 breech babies died, even in a dataset voluntarily submitted by midwives hoping to demonstrate good outcomes.

Additional high-risk findings from the MANA study:

• VBAC (Vaginal Birth After Cesarean):
  Neonatal death rate: 2.85 per 1,000, compared to 0.4 per 1,000 for first-time mothers.

• Twin births:
  Neonatal death rate: 13.4 per 1,000, compared to 1.3 per 1,000 overall in the dataset.

These are not rare complications. They are predictable risks—routinely attempted at home by CPMs despite data from their own organization showing the dangers.

MANA and Accountability

• No action was taken by MANA to discourage breech, VBAC, or twin births at home—even after their own published data showed clear danger.

• MANA dissolved in 2023 with no public reckoning over its role in promoting unsafe practices.

• The data remain online and are still used to defend midwifery legislation—often without proper context.

References

1. Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006–2009. Am J Obstet Gynecol. 2014;211(4):390.e1–390.e7. doi:10.1016/j.ajog.2014.05.005

2. Grünebaum A, McCullough LB, Brent RL, et al. Neonatal mortality of planned home births in the United States in relation to professional certification of birth attendants. Am J Obstet Gynecol. 2016;215(1):87.e1–87.e13. doi:10.1016/j.ajog.2016.03.033

3. Malloy MH. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004. J Perinatol. 2010;30(8):622–627. doi:10.1038/jp.2010.12

4. Chervenak FA, McCullough LB, Brent RL, et al. Planned home birth: the professional responsibility response. Am J Obstet Gynecol. 2012;208(1):31–38. doi:10.1016/j.ajog.2011.10.004

5. Sherman L, Le Coz E, Salman J. Failure to Deliver: A national investigation into the dangers of out-of-hospital births and the lack of accountability for non-nurse midwives. USA TODAY Network and GateHouse Media. 2018. Available at: https://stories.usatodaynetwork.com/failuretodeliver

6. Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014;59(1):17–27. doi:10.1111/jmwh.12172