In short, this study compared all BC planned midwife-attended home births with midwife-attended hospital births (the same midwives, since Canadian midwives practice both in home and hospital) and physician-attended hospital births. Both hospital groups met the same eligibility requirements for home births, meaning they were equivalent in health factors, risk status, etc. In other words, all of these women having hospital births could have chosen home births if they had so desired, under the BC midwifery regulations. From the abstract's conclusion:
Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.Like the Dutch home birth study that came out earlier this year (abstract available here), this Canadian study has a strong comparison group--something lacking in the CPM 2000 study in the BMJ.
I found the comment section in this news article about the study quite interesting. I really don't think most of the commenters actually read, or understood, what the study was saying. Rather, the comments were a series of emotional reactions for and against home birth. You know, "my baby would have DIED if I had been at home!" and "I will NEVER go to a hospital for childbirth again because it was so AWFUL!" Sometimes evidence from really good studies simply doesn't matter. It's more about emotion, perceptions of risk, and the need for a compelling narrative that makes sense of and gives finality to their birth experience.
I'm sure there is lots of discussion going on out there. For example, Woman to Woman Childbirth Education includes a comment by Gloria Lemay, in which she argues that the registration of BC midwives has not been a good thing overall. Any other good links/commentary about this study?