In 1978, Arizona began licensing lay midwives under regulations designed to maintain adequate standards of care for women desiring a home birth. During four years of this program, 3 per cent of home birth clients were hospitalized for complications and another 15 per cent received postnatal outpatient care, primarily for second degree lacerations. Five per cent of the newborns required medical care after delivery; half of these were hospitalized. Complications declined over the period due to increased experience, close supervision, and continuing education.