Written by Lori Smith BSN MSN CRNP
Pregnancy comes with a host of decisions to be made, including where to give birth.
While most women in the United States give birth in a hospital or birthing center, there are some who choose to have a planned home birth. This number isslowly increasing.
This article looks at what happens when someone plans to give birth at home. It includes information on the benefits, risks, and possible safety concerns.
Fast facts on home births
Here are some key points about home births. More detail and supporting information is in the main article.
- A doctor or midwife will decide if a home delivery is a safe option
- Some medical organizations are supportive of home births while others remain wary
- Women are advised to avoid home birthing if they have certain medical conditions
Planning a home birth
It is up to a doctor or midwife to decide whether or not a home delivery is a safe alternative for a mother and her baby.
After the birth of the baby, they will be examined by the midwife or physician, who will also support the mother during the period right after birth. If mother or infant needs to be transferred to a hospital at any point, the midwife or physician will arrange for this.
Not all health organizations are in agreement about home births. While the American College of Obstetricians and Gynecologists (ACOG) are hesitant about recommending planned home births, the American College of Nurse-Midwives (ACNM) are supportive.
In the opinion of the ACOG, the safest place for a woman to give birth is a hospital or birthing center. The ACNM strongly feel that a home birth is a safe alternative to giving birth in the hospital setting.
The one thing that both associations agree on is that a home delivery is not appropriate for all women or in all situations. Certain criteria must be met to consider home birthing as an option.
The criteria that should be met to consider a home birth include:
- A low-risk pregnancy
- Presence of a certified midwife or physician for the birth
- Living within 10-30 miles of a hospital and having readily available transportation
- Being pregnant with no more than one baby and that they are in the head down position
- Undergoing a spontaneous labor, or if the labor was induced, it was done in an outpatient setting
A healthcare provider may recommend avoiding a home birth if someone:
- Has certain medical conditions such asdiabetes, long-term high blood pressure, or seizures
- Has a history of cesarean delivery or other uterine surgery
- Has pregnancy complications such aspreeclampsia, breech presentation, or premature labor
- Is pregnant with more than one baby
- Is less than 37 weeks pregnant or more than 41 weeks pregnant
It is important for people to speak with their doctor or midwife about their specific risk factors or medical history that might make home birth inappropriate.
Possible benefits of a planned home birth
The benefits of a home birth may include the following:
- The birth can take place at home, a familiar and relaxing environment
- Loved ones can be present during delivery
- People can have more control of the labor process, such as the ability to move around during labor, choosing a position, bathing, and showering
- It may be easier to honor a religious or cultural history
- They can be less expensive
Planned home births can offer several potential health benefits, including lower rates of maternal infection and less maternal interventions. Planned home births have also been associated with fewer third- and fourth-degree tears and a reduced need for a cesarean delivery.
Possible risks of a planned home birth
The potential risks and disadvantages of having a planned home birth include:
- Inability to receive pain medication during labor and delivery
- Mid-labor transfers to hospital, which can occur in as many as23-37 percent of first-time deliveries
- Increased riskof death, seizures, and nervous system disorders in babies
Is a planned home birth safe?
Several studies discuss the safety of home delivery for low-risk pregnancies and deliveries that are attended by qualified birth attendants with access to hospital transfer.
One study published in the BMJ looked at the outcomes of planned home births attended by midwives. The authors came to a positive conclusion:
“Planned home birth for low-risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low-risk hospital births in the United States.”
A recent study published in the Journal of Midwifery and Women’s Health found that low-risk women “experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.”
For more information on planned home births or to find a birth attendant, people can visit theAmerican College of Nurse-Midwives or the Midwives Alliance of North America. People should also speak with their current doctor or midwife for assistance in working out if a planned home birth is the right option.
Written by Lori Smith BSN MSN CRNP