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List of milestones

To view the meeting material and minutes mentioned on this blog, please visit the public meetings page

Planned out-of-hospital birth

VbBS and HERC reviewed the draft coverage guidance and associated prioritization changes, and approved a revised version. The changes to the Prioritized List of Health Services take effect January 1, 2016.

Coverage guidance    Public Comment Disposition   Prioritization changes  


VbBS and HERC discussed this topic but did not complete the discussion. It will be carried to the 11/12/2015 meeting.


VbBS began its review of the topic and plan to continue at their next meeting in October. HERC has not yet reviewed the topic.


The draft coverage guidance, public comment disposition, and high risk conditions table are now available as they will be presented at the August 13, 2015 VbBS and HERC meetings. Note that changes appearing in underline/strikethrough were not reviewed by EbGS but were made by staff for consistency and clarity.


EbGS concluded its review of public comments, updated the coverage guidance and referred it to HERC.

New references added:

Birthplace in England Collaborative Group; Brocklehurst, P., Hardy, P., Hollowell, J., Linsell, L., Macfarlane, A., McCourt, C. … Stewart, M. (2011). Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: The Birthplace in England national prospective cohort study. British Medical Journal, 343, d7400. http://www.bmj.com/content/343/bmj.d7400.full.pdf+html 

Catling-Paull, C., Coddington, R. L., Foureur, M. J., Homer, C. S.; Birthplace in Australia Study; National Publically-funded Homebirth Consortium. (2013). Publically funded homebirth in Australia: A review of maternal and neonatal outcomes over 6 years. Medical Journal of Australia, 198(11), 616-20. https://www.mja.com.au/system/files/issues/198_11_170613/cat11665_fm.pdf 

Cheng, Y. W., Snowden, J. M., King, T. L., & Caughey, A. B. (2013). Selected perinatal outcomes associated with planned home births in the United States. American Journal of Obstetrics & Gynecology, 209(4), 325.e1-8. http://www.ajog.org/article/S0002-9378(13)00630-3/pdf 

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal , D., & Verdam, S. (2014). Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004-2009.  Journal of Midwifery & Women’s Health, 59(1), 17-27. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/epdf 

Davis, D., Baddock, S., Paiman, S., Hunter, M., Benn, C., Anderson, J. … Herbison, P. (2012). Risk of severe postpartum hemorrhage in low-risk childbearing women in New Zealand: Exploring the effect of place of birth and comparing third stage management of labor. Birth, 39(2), 98-105. DOI: 10.1111/j.1523-536X.2012.00531.x 

de Jonge, A., Mesman, J. A., Mannien, J., Zwart, J. J., van Dillen, J., & van Roosmalen, J. (2013). Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: Nationwide cohort study. British Medical Journal, 346, f3263. http://www.bmj.com/content/346/bmj.f3263.full.pdf+html 

de Jonge, A., Geerts, C. C., van der Goes, B. Y., Mol, B. W., Buitendijk, S. E., & Nijuhuis, J. G. (2015). Perinatal mortality and morbidity up to 28 days after birth among 743,070 low-risk planned home and hospital births: A cohort study based on three merged national perinatal databases. British Journal of Obstetrics and Gynecology, 122(5), 720-728. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13084/epdf 

Grünebaum A, McCullough LB, Brent RL, et al. Perinatal risks of planned home births in the United States. American Journal of Obstetrics and Gynecology 2015;212:350.e1-6. http://www.ajog.org/article/S0002-9378%2814%2901063-1/abstract 

Johnson, K. C., & Daviss, B. A. (2005). Outcomes of planned home births with certified professional midwives: Large prospective study in North America. British Medical Journal, 330(7505), 1416. http://www.bmj.com/content/330/7505/1416.full.pdf+html 

Kennare, R. M., Keirse, M. J., Tucker, G. R., & Chan, A. C. (2010). Planned home and hospital births in South Australia, 1991-2006: Differences in outcomes. Medical Journal of Australia, 192(2), 76-80. https://www.mja.com.au/system/files/issues/192_02_180110/ken10465_fm.pdf

Nove, A., Berrington, A., & Matthews, Z. (2012). Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: Results of an observational study of over 500,000 maternities in the UK. BMC Pregnancy & Childbirth, 12, 130. http://www.biomedcentral.com/content/pdf/1471-2393-12-130.pdf 

Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery & Women’s Health, 58(1), 3-14. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/epdf 

van der Kooy, J., Poeran, J., de Graaf, J. P., Bimie, E., Denklass, S., Steegers, E. A., & Bonsel, G. J. (2011). Planned home compared with planned hospital births in the Netherlands: Intrapartum and early neonatal death in low-risk pregnancies. Obstetrics & Gynecology, 118(5), 1037-46. DOI: 10.1097/AOG.0b013e3182319737    


EbGS continued its review of public comments but did not complete its review. EbGS will continue its review 6/4/2015.


EbGS reviewed public comment on the draft coverage guidance at its meeting February 5, 2015. The title was changed from "Home birth" to "Planned out-of-hospital birth."  The subcommittee requested new research from staff regarding risks to primaparous women. Discussion of public comments will continue at the 4/2/2015 EbGS meeting.


One of the source reports for this coverage guidance has been updated. The new citation is:

National Institute for Clinical Excellence (2014). Intrapartum care: care of healthy women and their babies during childbirth. Clinical Guideline 190, December 2014. Accessed December 15, 2014, from https://www.nice.org.uk/guidance/cg190/resources/guidance-intrapartum-care-care-of-healthy-women-and-their-babies-during-childbirth-pdf  (3/23/16 note: Link removed; no longer valid)


The draft coverage guidance has been posted for public comment. The public comment period ends at 8 a.m. Pacific time on December 15, 2014.


EbGS revised the draft coverage guidance and asked that it be posted for a 30-day public comment period.​


Updated source added:
College of Midwives of Ontario (2014). Consultation and transfer of care. Accessed October 1, 2014, from http://www.cmo.on.ca/?page_id=1026  (3/23/16 note: Link removed; no longer valid)


EbGS discussed the draft coverage guidance and will continue discussion at its meeting 11/6/2014.


A new source has been added to this coverage guidance:

National Institute for Clinical Excellence (2014). Intrapartum care: care of healthy women and their babies during childbirth Clinical Guideline 55, Draft for consultation, May 2014. Accessed August 12, 2014 from http://www.nice.org.uk/guidance/gid-cgwaver109/resources/intrapartum-care-update-nice-guideline2

Trusted Sources

Olsen, O., & Clausen, J. A. (2012). Planned hospital birth versus planned home birth. Cochrane Database of Systematic Reviews, 9.

Additional Sources
Cochrane, A. L. (2000). 1931-1971: a critical review, with particular reference to the medical profession. Medicines for the year, 1-11.

College of Midwives of British Columbia. (2014). Indications for discussion, consultation, and transfer of care. Accessed August 4, 2014 from http://www.cmbc.bc.ca/pdf.shtml?Registrants-Handbook-12-01-Indications-for-Discussion-Consultation-and-Transfer-of-Care  (3/23/16 note: Link removed; no longer valid)

College of Midwives of Ontario (2000). Indications for mandatory discussion, consultation, and transfer of care. Accessed August 4, 2014 from http://www.cmo.on.ca/resources/STANDARDS-OF-PRACTICE/3.%20CLINICAL%20PRACTICE/05b.Indications%20for%20Mandatory%20Discussion%20Consultation%20and%20Transfer_June%202000.pdf  (3/23/16 note: Link removed; no longer valid)

de Jonge, A., van der Goes, B. Y., Ravelli, A. C., Amelink‐Verburg, M. P., Mol, B. W., Nijhuis, J. G., et al. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529, 688 low‐risk planned home and hospital births. BJOG: An International Journal of Obstetrics & Gynaecology, 116(9), 1177-1184.

Dowswell, T., Thornton, J. G., Hewison, J., Lilford, R. J., Raisler, J., MacFarlane, A., et al.(1996). Should there be a trial of home versus hospital delivery in the United Kingdom? BMJ: British Medical Journal,312(7033), 753.

Hendrix, M., Van Horck, M., Moreta, D., Nieman, F., Nieuwenhuijze, M., Severens, J., et al. (2009). Why women do not accept randomisation for place of birth: feasibility of a RCT in the Netherlands. BJOG: An International Journal of Obstetrics & Gynaecology, 116(4), 537-544.

Hutton, E. K., Reitsma, A. H., & Kaufman, K. (2009). Outcomes Associated with Planned Home and Planned Hospital Births in Low‐Risk Women Attended by Midwives in Ontario, Canada, 2003–2006: A Retrospective Cohort Study. Birth, 36(3), 180-189.

Janssen, P. A., Saxell, L., Page, L. A., Klein, M. C., Liston, R. M., & Lee, S. K. (2009). Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal, 181(6-7), 377-383.

Netherlands Ministry of Health, Welfare, and Sport. (n.d). Final Report of the Obstetric Working Group of the National Health Insurance Board of the Netherlands (abridged version). The Hauge, NL: Government of the Netherlands. Accessed August 4, 2014 from http://blog.lib.umn.edu/kuli0015/studygroup/Dutch%20OB%20Indications.doc

Oregon Health Authority. (2013). Oregon Birth Outcomes by Planned Birth Place and Attendant. Accessed August 1, 2014 from https://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/birth/Documents/PlannedBirthPlaceandAttendant.pdf

Wax, J. R., Lucas, F. L., Lamont, M., Pinette, M. G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American journal of obstetrics and gynecology,203(3), 243-e1.

Zeitlin, J., Mohangoo, A., Alexander, S., Barros, H., Blondel, B., Bouvier-Colle, et al. (n.d). Health and Care of Pregnant Women and Babies in Europe in 2010. Accessed on August 1, 2014 from http://www.europeristat.com/images/doc/Peristat%202013%20V2.pdf

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