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Should I have a homebirth?

In this post, I will talk about Home Births. Freestanding birth center births and hospital births will be addressed in future blog posts.

Early in your pregnancy, it is important to make informed decisions about where you give birth. There are several factors to think about such as location of your preferred provider, where you feel safest and financial and insurance concerns. The decision of where you give birth impacts your involvement with decision making during labor and delivery, the type of care you receive and the choices and options you have during labor.

If you are a healthy pregnant woman, the choices can include a hospital birth, a freestanding birth center or a home birth. If you are at risk for a medical condition or currently have one, you will likely want to plan a hospital birth with an obstetrician. Your care provider can tell you about situations that could require more specialized care.

This decision goes hand in hand with which maternity care provider you use. Home and freestanding birth centers generally use a midwifery team where as a hospital birth will use an OB or a midwife.

What is a Homebirth?

Simply put, a homebirth is giving birth to your child in your residence rather than a hospital or birth center. These births can be planned or unplanned. For the sake of this post, I will focus on planned homebirths

To have a homebirth, you like likely still need the assistance of someone experienced and qualified during labor and delivery. This can be

  • a certified nurse-midwife (CNM)
  • a certified professional midwife (CPM) or other direct-entry midwife
  • a midwife whose education and licensure meet international standards
  • a naturopathic or medical doctor who practices obstetrics

Is a Homebirth Safe?

This is tricky. It really depends on who you ask or where you get your information. Neither the American Academy of Pediatrics (APA) nor American College of Obstetricians and Gynecologists (ACOG) currently recommends homebirths. They maintain hospitals and birthing centers are the safest option.

A 2014 study including nearly 17,000 women who had a planned home birth with the assistance of a midwife found that there was no significant increase in neonatal death compared with planned hospital births. This study can be seen in the National Library of Medicine. This landmark study confirms the safety and overwhelmingly positive health benefits for low-risk mothers and babies who choose to birth at home with a midwife. At every step of the way, midwives are providing excellent care.

“Home birth mothers had much lower rates of interventions in labor. While some interventions are necessary for the safety and health of the mother or baby, many are overused, are lacking scientific evidence of benefit, and even carry their own risks. Cautious and judicious use of intervention results in healthier outcomes and easier recovery, and this is an area in which midwives excel. Women who planned a home birth had fewer episiotomies, pitocin for labor augmentation, and epidurals”.

“Most importantly, their babies were born healthy and safe. Ninety-seven percent of babies were carried to full-term, they weighed an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions. Babies born to low-risk mothers had no higher risk of death in labor or the first few weeks of life than those in comparable studies of similarly low-risk pregnancies”. 

There is still a lot of debate around the safety of planned home births. However, there are numerous factors to consider before you make the decision. For low risk pregnancies, the risk of neonatal mortality in home births is not significantly higher than in a hospital, as long as a trained medical professional is present to assist.

What Does it Mean to be Low-Risk?

As mentioned before, studies have shown that homebirth for low-risk mothers have very positive outcomes. But what does it mean to be low risk? Low risk mothers are free of conditions such as heart disease, kidney disease, blood clotting disorders, type I diabetes, gestational diabetes managed with insulin, preeclampsia, bleeding (that is separate from bloody show) or placenta previa at beginning of labor. This is not an exhaustive list. Please contact your health care professional about any health conditions you may have.

What is a Hospital Transfer and why would I need it?

During a planned home birth, you might need to be transported to a hospital for monitoring or treatment if complications develop. While this is not an exhaustive list, your health care provider might recommend transfer to a hospital if:

  • Labor isn’t progressing
  • Your baby shows signs of distress
  • Your baby presents in a position other than headfirst
  • Pain relief is needed
  • You have high blood pressure
  • You experience bleeding

Pros of a homebirth

  • a familiar, comfortable setting
  • more control
  • no pressure to use medications or interventions
  • high chance of having a vaginal birth
  • more support and individualized care than in a hospital
  • opportunity for unlimited skin-to-skin time with baby after birth
  • high rates of exclusive breastfeeding
  • reduced cost
  • religious or cultural considerations
  • convenience when previous births have happened very quickly
  • freedom to labor as you wish
  • eat or drink
  • take warm showers or baths
  • use candles or aromatherapy

Cons of having a homebirth

  • It is not a safe option for everyone, depending on your individual risk factors.
  • Insurance may not cover any associated costs.
  • You could still be transferred to the hospital in the event of an emergency.
  • Birth can be messy, so it’s best to be prepared with plastic sheets and clean towels.

If you are considering homebirth, learn about others’ experiences, read read read, and talk to your doctor or midwife. Once you are cleared for having a homebirth, enjoy the process and don’t forget to hire your birth photographer and doula! I have an option for both here.

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