Home Birth: Is It Safe?

Home birth has been embraced by many natural mamas and is increasing in popularity… again!

Home birth was the norm until the early part of the 20th century when women started going to the hospital (and sometimes not making it there!) to give birth. So home birth is the traditional way of birthing a baby but, is it safe?

Before we start – a free gift for you

Interested in a home birth? Check out this free little quiz we put together that will help you see if home birth is a good fit for you.

Download our free quiz and see if home birth is a good fit for you.

Home birth is a safe choice for most women

Studies are piling up that show home birth is very safe for low risk women. In fact, British regulators are urging women to consider home birth because home birth can be safer than a hospital birth for many women. But how?

Midwifery care lowers the risk for interventions

Midwifery care has been shown to lower the risk of medical interventions for low risk women. One reason may be that fear of childbirth slows labor (more about this later). Being at home or a home-like environment without beeps and wires, can help mom to relax and feel safe. Another reason is that care is simply better. Midwifery care is evidence based care which is very different from the standard care of US hospitals. Evidence based care doesn’t routinely rupture membranes, induce without cause, or inhibit mom from moving or eating and drinking. None of these interventions are evidence based yet hospitals routinely perform them. And finally, hospitals have protocol and policies. It’s difficult for staff to give individual care when they have to adhere to these guidelines. Hospitals are businesses that need to function profitably. Birth is sometimes slow and always unpredictable. Keeping labor on a timeline helps keep things moving along. Midwifery care for home birth or birth center birth is individualized and encourages labor to begin on it’s own and progress on it’s own, assuming everything is normal.

Midwives are trained professionals

Home birth doesn’t mean there is no help available if something unexpectedly goes wrong. There are many studies that show that perinatal outcomes for low risk women in planned home birth are as good or better than those from planned hospital births. Women who plan a home birth or birth center birth know that if a complication arises that would make a hospital birth safer (preeclampsia, twins, preterm birth) their midwife will tell them and make the arrangements. Midwives are trained to notice complications at each prenatal appointment so that they can discuss transferring care if needed. During labor they will also keep monitoring you and baby to be sure labor is progressing normally. Midwives are trained to notice complications before they become emergent. In fact, most transfers are not emergencies which means you and your partner can have time to discuss options and make peace with your decision. Midwives are also prepared with oxygen, medications to stop bleeding, supplies to start an IV, and resuscitation skills if needed and will not hesitate to call 911 in an emergency. In fact, midwives carry with them almost all of the emergency supplies that a hospital has, excluding a cesarean section and NICU team.

“I’ve heard that home birth is unsafe and reckless. What gives?”

Some believe that home birth is a medieval healthcare option. Others think home birth is selfish because moms just want to be comfortable without regard for their baby’s health. All of these assumptions are wrong and disproven by science.

Birth is a normal biological function

The problem is that the people who believe that home birth is reckless think about birth as a medical condition. That means that they compare childbirth to open heart surgery or an appendix removal, both of which would be safest to do at a hospital (and unsafe anywhere else). The truth is childbirth is more like having a bowel movement. It’s a normal biological function that usually happens just fine on it’s own. Of course serious complications can arise, which is why birth, unlike a bowel movement, is attended by trained professional.

Studies are biased

Many studies that show adverse affects from home birth are not quality studies. For example, one group of physicians urged doctors to discourage home birth and suggested that anyone who supported home birth should be “subject to peer review and justifiably incur professional liability and sanction from state medical boards”. These practitioners opened their argument with research that included unplanned home births which has been greatly criticized. Wendy Gordon LM, CPM, MPH, writes:

 “The authors cited several more poor-quality studies, as well as 52 citations of commentaries, opinions and anecdotes (some even pulled from the popular media) to build their “evidence” basis. They conveniently ignored the large and growing body of literature that continues to show that planned home birth with qualified and experienced midwives holds no greater risk of perinatal mortality than birth in the hospital, and in fact results in far fewer interventions and lower risk of maternal and perinatal morbidity.”

Another flawed study relied on birth certificate data to conclude that still births are 10 times more likely in home birth. In reality, these researchers studied 5 min Apgar scores of zero, NOT stillbirth and that information was pulled from birth certificate records which are proven by birth certificate scholars and epidemiologists to be unreliable for studying home birth safety. Another important thing to note is that birth certificates don’t note intended place of birth so there is no distinction between unplanned (and possibly unassisted) home birth and planned home births, nor a distinction between planned hospital births and transfers. We know that home births that are not attended by a qualified midwife or other healthcare provider have significantly more risks than those that are planned in advance and involve certified nurse midwives, certified professional midwives, or physicians. An important study shows that home birth for low risk women reduces the rate of interventions without increasing adverse outcomes. The reason this study is so important is that it’s the first one to account for planned place of birth instead of just actual place of birth. That means that it included women who gave birth in the hospital but had planned a home birth, showing that yes, women can plan a home birth and transfer to hospital if needed without any adverse affects to mom or baby. This study just adds to the growing pool of information that shows home birth is safe.

Hospital birth carries hidden risks

Some may argue that the hospital is the best place to give birth because you are near help if it’s needed. This theory could be correct if hospital birth didn’t come with it’s own set of serious risks.

Infection

Hospital associated infections (HAIs) are a well known cause of morbidity and mortality in the United States. The CDC states that at least 1 in 25 patients acquires a hospital associated infection. Home birth may have fewer neonatal infections because a persons home does not have the resistant superbugs that a (sterile) hospital does or that mom and baby are already inoculated to their environment.

Fear and the cascade of interventions

Hospitals are not home like. For a lot of women, even if they believe, intellectually, that the hospital is the safest place to birth, their primal subconscious (the part that gives birth) knows that home is much safer because it’s familiar. When a laboring mom is fearful she releases adrenaline which interferes with oxytocin and stops or slows labor. In nature this is a good thing. If there is a danger nearby mom needs to get somewhere safer for birth. However, in the hospital this means her labor has “stalled” and she will probably be given pitocin to get it going again. The use of pitocin can increase the pain mom feels since pitocin doesn’t cross the blood brain barrier like oxytocin does. This means that endorphins aren’t released for pain relief. From here it’s much more likely that mom will need pain meds, assisted delivery or c-section. Low risk women who choose to birth in a hospital are much more likely to have third and fourth degree tears, hemorrhage and c-section than low risk women who choose home birth. the U.S. C-section rate for low risk women planning a hospital birth lingers around 30% while women who have planned a home birth or birth center birth have a much lower risk, about 5%.

Early cord clamping and infant separation

Early cord clamping was found to lower a newborns blood volume by as much as 40%. Losing that much blood doesn’t happen at any other time of life without severe consequences, including death. This blood volume reduction increases the need for blood transfusions. You can ask for your doctors not to clamp or cut the cord until the placenta stops pulsating, but keep in mind that they may do it anyway if even the slightest complication arises (like meconium in the water), even though this isn’t evidence based practice. If there is meconium in the water or another reason that baby needs attention you will often be separated. Even a short amount of separation can interfere with bonding and breastfeeding. A separation in the first hour of life means that baby is not stimulating moms nipples to release oxytocin which helps contract the uterus and avoid postpartum hemorrhage.

Is a home birth right for you?

Here are some guidelines. Of course, talk with your healthcare provider to make the best decision for you and your family.

Home Birth may be a great option for you if…

  • You are low risk
  • You want individualized and evidence based midwifery care
  • You want to avoid unnecessary interventions
  • You trust the evidence that proves it’s safe
  • You want to avoid traveling while in labor (especially great if you have a history of quick labors)

Home birth may not be a good fit if…

  • You don’t believe it’s safe
  • You don’t live near a good hospital (in which case a birth center may be a better choice)
  • You are carrying multiples
  • You have uncontrolled diabetes
  • You have preeclampsia or high blood pressure
  • You have had a previous C-section (this is debatable depending on what resources are available in your area. For more on HBAC, visit VBAC Facts.)
  • You go into labor early (before 37 weeks)
  • You’ve got a breech baby–although some home birth providers, such as Dr. Stuart Fishbein, specialize in breech home birth.

Want to see if home birth is a good fit for you?

Download our free quiz to see if a home birth may be right for you.            

What about You?

Did you have a home birth? Do you believe they are safe?

 

References

  • http://www.cdc.gov/HAI/surveillance/index.html
  • http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/
  • http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html?_r=0
  • http://mana.org/index.php?q=blog/0/understanding-outliers-in-home-birth-research
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8 Comments

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  1. I had my first child in hospital as I could not find a midwife when I was pregnant, my mum was with me thank god, and stopped the doctors from interfering, my next three children were all home births and easy as, the last was 6 weeks premature and no problems, don’t believe the lies that birth is dangerous, it’s the hospitals that are the danger, birth is natural and 95% of all birth is normal. Do check out Jeanice Barcelo The dark Agenda Behind hospital births, YouTube, this will soon explain why home births are so much better.

  2. My mother-in-law is vehemently against homebirth. I read some where that hospital births had a higher mortality rate for mothers and infants than home births. I cannot find that information any more. Do you know those numbers or know where I can get that information? Thank you!

  3. I’m supportive of safe homebirth. I had my first child at home this July. It was incredible and it absolutely saved me from an unecessary c-section. I had a 50+ hours of active labor with a 9 lb 11.5 Oz baby with a hand up. While the baby was perfectly healthy, I suffered a very close call. I hemorrhaged from a retained placenta on top of the third degree tear I had. Thankfully I had a capable midwife who manually removed my placenta. This was a significant hemorrhage, there was no time to get to the hospital.

    I live in a state that homebirth is neither legal or illegal. That means midwives do not have legal rights to use simple life saving drugs if needed and there are no regulations /reporting on midwives and their qualifications. Thankfully I had a midwife that was willing to do everything she could to save me, including go to jail. Along with manually removing my placenta, I was *illegally* given pitocin and a midi pill to stop my hemorrhage. I would be dead right now had I choose a midwife that did not have those skills or those meds and the balls to use them and face the consequences.

  4. I had my first child at home in March 2015 and it was the most amazing experience. Being able to just sit in my own living room, rocking in the chair I would eventually spend many hours nursing in while I stared at the fire in our fireplace while I was in labor. Having my dog quietly laying next to me just “being there”. After about 12 hours of labor & a few of pushing I gave birth to our son in our bed. I was wonderful and so intimate to just have my husband & 2 midwives who we both developed a close relationship be there and witness the natural miracle of birth. I look forward to having another child and planning another home birth. I feel as if the second time around it will be even more special because we plan on having our son there as well. <3

  5. I had a wonderful home birth last June with my first child! The only time I even felt the slightest bit afraid was when my husband called the midwife and I heard him tell her I was having contractions. I was like, “wait, I am?!” Lol
    The birth went perfectly and we’re having another one cone August. Praying it goes as well as the first!

  6. I’m an L&D nurse who has worked at 3 hospitals. I’m pro a homebirth in the right circumstances, but this article has some inaccuracies regarding what goes on in the hospital, and therefore fear mongering. All 3 places that I’ve worked greatly promoted mother baby bonding, and only seperated them in extreme safety situations. NRP guidelines state that if a baby with meconium is born vigorous and crying spontaneously, they are placed directly skin to skin. Otherwise they are suctioned as I’m sure they would be at a home birth by the midwife. We routinely allow the umbilical cord to pulsate, and never rush a laboring woman. There is not timetable on her labor, unless she or her baby start to show signs of distress. While hospital acquired infections are definitely a valid concern, they occur in the perinatal and well newborn population at a fraction of the general hospital population.

  7. I had a home birth last November 2014 with my first child. It was the most amazing experience and from what I’ve heard from other mothers and friends about recent births in hospital, I had a much more pleasant experience and with far better care. I love that I got to see the same midwife everytime, if you go into hospital you see someone different each time you go to an appointment. So you get to have a good bond with the person who will deliver your baby and feel much more comfortable when in labour. Also they are very well trained to know when a labour isn’t going right and a mother is needing to go into hospital. I would highly recommend it to anyone who can have a home birth to do it! X

  8. I had the most amazing home birth! But in the Netherlands it is more common – pregnant women can choose whether they would like to deliver at home or in the hospital – if there are no complications during pregnancy or anticipated higher risks.
    I felt very comfortable and relaxed at home and it was very special to deliver our son at home. Taking a shower in your own bathroom, getting in your own bed afterwards and not needing to get into a car is just great! 🙂

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