Home Birth: What you need to know

Home Birth: What you need to know

Monica Basile, PhD, CPM, LMT

Home birth is a safe and reasonable alternative to hospital birth. For many families, home birth provides optimal conditions for achieving physiologic birth in a familiar and intimate setting, with personalized and expert care.

How common is home birth?

The CDC reported in 2012 that home birth is on the rise nationally.[1] While less than 1 percent of all births in the United States take place outside the hospital, the number of these births increased by 3.5 percent between 2003 and 2006. The CDC reports that Iowa’s rate of home birth is significantly higher than the national average. Approximately 500 women give birth at home every year in Iowa.

Why do people choose home birth?

Photograph submitted by the family.

Photograph submitted by the family.

People choose home birth for a variety of reasons based on physical, emotional, cultural, and spiritual factors. Those who decide to birth at home span socioeconomic classes and they come from every demographic,  profession, and religious and political affiliation. A 2009 study in the Journal of Midwifery and Women’s Health reported on the motivations people cite for choosing home birth.[2] The most common were:

 

  • Increased safety (24%)
  • Avoiding unnecessary interventions (24%)
  • Previous negative hospital experience (23%)
  • More control and autonomy (22%)
  • Comfortable, familiar environment (19%)
  • Trust in the birth process (16%)

 Is home birth safe?

Many peer reviewed, scientific studies have found that for healthy women who experience normal pregnancies, a planned, midwife-attended home birth is just as safe as hospital birth, with far lower rates of medical interventions.[3] While the nationwide cesarean rate is over 30 percent, the rate of transfer for a cesarean during a planned home birth is only 3.8 percent. The safety of home birth has been affirmed by public health organizations such as the World Health Organization and the American Public Health Association.[4]

 What type of care do home birth midwives provide?

Home-birth midwives specialize in providing primary health care in out-of-hospital settings, and in supporting women to maintain a healthy pregnancy and birth. They provide comprehensive prenatal, birth, and postpartum care to low-risk women. Home-birth midwives can also recognize deviations from the norm and they will refer care to other healthcare providers when appropriate. There are several types of midwives who attend home births: Certified Nurse Midwives (CNMs), Certified Professional Midwives (CPMs), and Traditional Midwives.

The average length of a prenatal visit with a physician is 10 minutes, whereas the average length of a prenatal visit with a home-birth midwife is about an hour. Home-birth midwives value respectful treatment, personal attention, informed decision-making, appropriate monitoring and risk assessment, instilling confidence in a woman’s body, natural techniques for comfort in labor, family-oriented care, and parent-child bonding. Six weeks after a home birth, more than 90 percent of mothers are breastfeeding successfully.[5] The midwifery model of care is holistically oriented, seeking to enhance the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Midwives also offer excellent continuity of care.

What about complications?

Photograph by Laura Eckert, A New Creation Photography

Midwives screen clients carefully and care for only healthy, low-risk women. Midwives are trained in emergency skills such as neonatal resuscitation, and in facilitating a safe transfer of care, if needed. The vast majority of transfers during labor, from home to a hospital setting, are non-emergent.

 

 

Is home birth for everyone?

No. Home birth is contraindicated for women who have risk factors for certain health conditions, or for those who develop complications arising during pregnancy. Also, it is not for women who have a personal preference for birthing in the hospital.

References:

[1] MF MacDorman, TJ Mathews, E Declercq. “Home births in the United States, 1990–2009.” NCHS data brief, no 84. Hyattsville, MD: National Center for Health Statistics. 2012.

[2] Debora Boucher, CNM; Catherine Bennett, RNC, BSN; Barbara McFarlin, CNM, PhD, RDMS; Rixa Freeze, PhD, MA “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” JMWH, Vol. 54, No. 2 (March/April 2009), p. 119.

[3] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June); S Vedam, K Stoll, L Schummers, C Fulton, “Home Birth: An Annotated Guide to the Literature, 2013.

[4] American Public Health Association, “Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002; Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, “Care in Normal Birth: A practical guide.” World Health Organization, 1996.

[5] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June);

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