home delivery

Is your bedroom a safe place to give birth?

During her first pregnancy, Pamela Garringer wanted to give birth at home. But, being a bit anxious, she decided to have her baby in the hospital. As it turned out, Garringer didn’t like the unfamiliar room or the way the nurse immediately whisked baby David away, so her next three children were born at home. She remembers the sunlight shining through her window as Hannah was born. Elisabeth and, later, Josiah came along in the middle of the night while the older children slept in the next room.

Garringer, 38, of Pleasant Prairie, Wis., doesn’t consider herself unconventional. But despite the recent publicity surrounding model Cindy Crawford’s home birth, there’s nothing typical about having a baby this way in the United States: A mere 23,000 of the 4 million babies born each year are delivered at home. Some experts believe that number could safely be higher, however.

The trade-offs

Most women who want a home birth believe that having a baby is a normal process requiring little medical intervention. Many also want more control and personal attention than they might get in a hospital. But if you choose to take this route, you may be making some trade-offs.

For example, you probably won’t find an obstetrician who’s willing to deliver your baby at home. While a few family physicians will, most such births are attended by midwives. (Certified nurse-midwives have passed a national board examination in midwifery with supervised clinical experience; lay midwives may or may not have passed a written exam, and

licensing varies from state to state.) Also note that you should enlist a doctor as backup if a midwife is attending the birth and find a pediatrician who’ll see the baby within 24 to 48 hours.

Be aware that you’re also giving up some forms of medical assistance. “You’re making a commitment to a natural childbirth,” says Alice Bailes, chairwoman of the home-birth committee of the American College of Nurse-Midwives and a certified nurse-midwife in Alexandria, Va., who has attended more than 1,000 home births. That means no drugs to speed labor or epidural for pain, since these interventions restrict you to bed for constant fetal and maternal monitoring and to receive IV fluids. (Your baby’s heartbeat will be checked with a device placed on your abdomen.) Instead, home-birthing women rely on relaxation techniques, positioning and supportive coaching.

Is it safe?

Even the most ardent home-birth advocates agree that what counts most is safety. Studies published in Britain and the Netherlands show that for a healthy woman with a low-risk pregnancy, home birth is a safe option, says Paul Van Gorp, M.D., a family physician in Long Prairie, Minn., who helped the American Academy of Family Physicians write its policy on home births.

Conditions that make a hospital the safer choice include high blood pressure, gestational or insulin-dependent diabetes, severe anemia, preterm labor, unexplained vaginal bleeding, carrying twins, a pregnancy that goes beyond 42 weeks or a baby in the breech position.

To help ensure the safety of mother and baby, many midwives require that the woman’s home be no more than 30 minutes from a hospital. Based on a Columbia University study published in Obstetrics and Gynecology, transfer to a hospital occurs in only one in 10 planned home births attended by certified nurse-midwives. The most common reason is failure to progress, which occurs most often with first-time mothers.

The American College of Obstetricians and Gynecologists holds firm that the hospital is the safest place for mother and baby. “You can screen people, but there are still [dangerous] things that can happen that you can’t predict,” says Hal Lawrence, M.D., director of the obstetrics and gynecology department at Mountain Area Health Education Center in Ashville, N.C. For example, in about 1 percent of pregnancies, the placenta separates from the wall of the uterus; in other cases, the umbilical cord precedes the baby and becomes compressed, cutting off the oxygen supply.

Still, Garringer says, for her, having a baby in the hospital didn’t compare to her home births. “I loved being in my own bed and nursing my babies right after they were born,” she says. “It changes your life.”