Home Birth: How to Prepare

Home birth is a hotly debated topic across professional organizations, healthcare providers, websites, and blogs. Parents are recognizing their options and make informed decisions regarding the birth of their children. In the United States, home births increased by 12% between 2020 and 2021, which follows a 22% increase from the previous year. The COVID-19 pandemic and concerns over the safety and access to hospitals certainly contributed to this increase.

Key takeaways:
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    The official position of professional organizations in the United States is that a hospital setting is the safest place to deliver your baby.
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    Your ability to make your own, informed medical decisions should be respected.
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    Home birth should be attended by two appropriately licensed and credentialed practitioners.
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    There are many advantages to a home birth that make it an appealing option for families.
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    It is important to consider the distance and your ability to get to the nearest hospital should the need arise during the home birth.

Before deciding to birth your baby at home, it is crucial to have up-to-date information so you can consider the safety, advantages, and disadvantages of home birth.

Is home birth safe?

There is a differing of opinions between European obstetric organizations and American obstetric organizations. If you are considering a home birth in the United States, it is important to know the recommendations of American organizations when speaking with your healthcare provider.

Clear evidence regarding the safety of home birth is lacking and often inconsistent. Most evidence is the result of observational studies, as opposed to clinical trials, that often have limitations. Most information is gathered from birth certificates, which are not always clear or consistent across states, and self-disclosure from providers.

In the United States, analysis has shown that home birth, when compared to hospital birth, is associated with a two to three-fold increase in infant death, low APGAR scores (a measure of the infant’s initial well-being), infant seizures or other serious neurological conditions.

Barriers to a safe home birth include lack of consistent state laws and regulations, differences between licensed providers, ability to seek special consultation from other healthcare providers and ease of transfer to a hospital during or after labor if necessary.

It is the consensus among all professional organizations, internationally and state-side, that home births should be reserved for low-risk pregnancies. The American College of Obstetrics and Gynecology (ACOG) a renowned professional organization that establishes practice guidelines for OB/GYNs and the American Academy of Pediatrics (AAP) believes that a hospital is the safest place for mother and baby. ACOG, the AAP, and the American College of Nurse-Midwives (ACNM) also recognize and encourage women to make medically informed decisions regarding birth.

With that in mind, there are many things to consider if you desire a home birth.

Who should attend a home birth?

It is essential that your home birth provider has the correct licenses, training and education. Appropriate providers include:

  • Certified Nurse - Midwife.
  • Certified Midwife: Midwife whose training meets the standards of the International Confederation of Midwives’ Global Standards for Midwifery Education.
  • Physicians practicing obstetrics are also suitable, though less common in home birth.

Any of these practitioners should be accessible for consultation at any time throughout the pregnancy. Additionally, newborns must receive the same care at home as they would in a hospital setting. Two providers should be present at birth, with one provider taking full responsibility for the delivered infant. Providers should have all the necessary equipment and be certified in neonatal resuscitation. The newborn provider must be capable of performing newborn health assessments and addressing any health concerns that may arise.

Criteria for home birth

Home birth is reserved for pregnancies that are considered low-risk. A low-risk pregnancy meets the following criteria:

  • Absence of existing maternal disease.
  • Absence of significant disease that develops during pregnancy.
  • Pregnancy gestation of 37 weeks to 42 weeks.
  • One baby that is measuring appropriately for gestational age.
  • Head down presentation.
  • Labor that begins on its own or can be safely induced as an outpatient.

Parents choosing home birth should be educated by their healthcare provider about the risks involved including fetal or infant death, infant seizures, and lower APGAR scores.

Who should NOT have a home birth?

There are a few contraindications or reasons why you should not attempt a home birth:

  • Multiple gestation: twins, triplets, etc.
  • Malpresentation: a baby that is not head down in the birth canal. Examples include breech or transverse position.
  • Previous Cesarean delivery.

Advantages to home birth

There are many perceived advantages to home birth that many birthing parents feel may be compromised in a hospital setting:

  • Fewer medical interventions, such as induction of augmentation of labor, fetal heart rate monitoring and access to pain medication.
  • Decreased risk of perineal or vaginal tears and episiotomies, a purposeful cut made into the perineum to aide in delivery of infant.
  • Greater control over decision making process: Women have reported that during hospital births they felt they lost their ability to make decisions or consider choices.
  • Limited interruptions and distractions.
  • Control over cultural considerations.
  • Comfortable environment.
  • Higher patient satisfaction.
  • Potentially lower cost.

Special considerations about home birth

Distance from a hospital with an active maternity unit is an important factor when considering home birth. Studies have shown that 23% to 37% of nulliparous women (first time mothers) needed to be transported during labor to a hospital. Multiparous women, who have had two or more children, required transfer in 6% to 9% of cases.

However, another study by the Midwives Alliance of North America Statistics Project reported that only 11% of patients needed to be transferred to a higher level of care.

A longer distance from a higher level of care is associated with increased risk of death of the mother and/or the infant. It is necessary step to ensure safe and timely transport to a higher level of care during home birth preparation.

Reasons you may need to be transferred to the hospital include:

  • Labor that has not progressed.
  • Your baby is not head down.
  • Your baby is in distress.
  • You develop a fever or high blood pressure.
  • You begin bleeding heavily.
  • You need pain relief.

Once you decide that home birth is the right option for your family, your first step will be to find an appropriately licensed provider to aid you in your birth journey. This provider should be able to answer all your questions and concerns. Your next step will be to develop a birth plan. Your birth plan is a guide for yourself and your healthcare practitioners. This plan will help you create and anticipate the birth experience you desire.

Considering a home birth can be fraught with differing opinions, safety concerns and desire to control a deeply personal experience. Parental autonomy the ability to make your own educated healthcare decisions is incredibly important and should be respected by the healthcare providers involved in your pregnancy care.

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