Nurse - midwives demonstrated with a high grade level of evidence a lower rate of cesarean sections, lower apgar scores,
lower labor augmentation, lower episotomy rates, equivalent low birthrates, lower vaginal operative deliveries, less use of labor analgesia and epidurals, and lower rates of third - and fourth - degree perineal lacerations.
Planned out - of - hospital birth also had a statistically significant association with higher rates for 5 - minute Apgar scores of less than 7, neonatal seizures, neonatal ventilator support, maternal blood transfusion, and unassisted vaginal delivery but with
lower rates of both admission to neonatal intensive care units and obstetrical interventions, including induction and
augmentation of
labor, operative vaginal delivery, cesarean delivery, and severe perineal lacerations.