Home birth is a hot topic in the realm of labor and delivery. According to the Midwives Alliance of North America (MANA), the number of homebirths in the United States rose by 41% between 2004 and 2010. This sharp increase has not only focused the spotlight on homebirth, it has caused medical researchers and clinicians to review study after study, and patient (hospital) record after client (homebirth) record to make a more accurate assessment of the safety of homebirths.

In MANA’s landmark study, which analyzed the records for 16,924 women, researchers foun, “Low-risk women in this cohort experienced high rates of physiologic [natural] birth and low rates of intervention without an increase in adverse outcomes.”

In another recent study, which reviewed 5418 women planning homebirths found, “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.”

7 Considerations Before Choosing Home Birth

After a review of the most recent data, the ACOG (American College of Obstetricians & Gynecologists), while acknowledging certain aspects of the safety and efficacy of homebirths in low-risk women using certified professional midwives, believes, “…hospitals and birthing centers are the safest setting for birth, [but] it respects the right of a woman to make a medically informed decision about delivery.”

Therefore, it’s important that mothers weigh 7 important considerations before making the decision to pursue a planned homebirth.

1. Is the pregnancy low-risk? When reading study statistics, skimming isn’t an option. It’s important to note that the most recent studies review low-risk, planned homebirths. This rules out any homebirths for high-risk pregnancies, including:
   —Mothers 35-years and over.
   —Women pregnant with multiples (twins, triplets, etc.)
   —Mothers with gestational diabetes, pre-eclampsia or high blood pressure.
   —Mothers with certain pre-existing medical conditions.
   —Women who abuse alcohol or drugs.
   If you are unhealthy in any way, and/or your pregnancy is considered high-risk, you should only consider a delivery at a birthing center and/or hospital.
2. Are you healthy? As mentioned above, certain pre-existing medical conditions, including diabetes, epilepsy, severe anemia, certain mental health conditions, heart disease and others put you at much higher risk for pregnancy and labor complications. If your health is at all in questions, home birth should not be considered. A review of your medical history as well as continuous prenatal visits will determine whether you are healthy enough to consider homebirth.
3. What are the qualifications of the midwife? The studies cited above reviewed data from homebirths facilitated by midwives with the highest of qualifications. Only Certified Professional Midwives should be considered for a home birth because they are the only midwives that carry a certification requiring knowledge about and experience in births that take place out-of-hospital settings.
4. Is your baby breech? In most states, it is considered illegal for a midwife to deliver a breech baby at home if she is aware the presentation was breech at the most recent prenatal check-up and/or prior to the baby’s delivery. Breech babies are considered high-risk as well, and most breech babies are now born via caesarian section to reduce the risk to mother and child.
5. Is the homebirth planned? This may sound silly, but some women are on the fence about whether they want to deliver at home or in a hospital and so they wait until they’re in labor to decide. The statistics supporting the safety of homebirth are based entirely on planned homebirths, where women were treated by midwives during the prenatal period. The midwifery model of care is essential in optimizing planned homebirth outcomes because it gives the midwife the opportunity to change your birthing plan if risks or conditions shift by the time the mother goes into labor.
6. What is your stance on medical interventions? If you are a healthy woman with a low-risk pregnancy, and you’re interested in natural childbirth, you are a good candidate for homebirth. There is no disputing that the use of medical interventions (like Pitocin, epidurals, caesarian sections, etc.) are on the rise and there can be adverse reactions and outcomes when they are used electively. Women who birth at home inherently use far fewer interventions than those who have hospital births. Even the 10% to 12% of women who are transported to the hospital from a homebirth use fewer interventions. Fewer interventions can mean a safer and healthier outcome for both mother and baby.
7. Are you open to collaborative care? One of the reasons homebirth is on the rise is that women are understandably concerned about the rise of medical intervention and C-section rates in the U.S. This is why it is so important to choose an OB and/or midwife who supports your birthing plan. Collaborative care, which pairs OBs and state-of-the art hospital delivery rooms and/or birthing centers with licensed midwifery care, offers the ideal middle ground. Wherever midwives are involved, we see lower rates of intervention and higher rates of postpartum satisfaction – including better breastfeeding statistics.

Are you interested in including a midwife in your birthing plan? Contact Women’s Health Associates to learn more about home birth, birth center and midwife-centered prenatal and postpartum care.

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