Home, Sweet Home
For some women, there’s no place they’d rather have their baby. Is this wise?
Sparring Over Safety
While the American Public Health Association supports home birth, the American College of Obstetricians and Gynecologists (ACOG) opposes it, even for low-risk women, as does the American Medical Association. The American College of Nurse Midwives (ACNM) says a planned home birth can be a safe option for low-risk women who are attended by a certified nurse-midwife or certified midwife (to find one, go to acnm.org).
Research supports this claim. A study published this year in the British Journal of Obstetrics and Gynecology looked at more than 500,000 births to low-risk women in the Netherlands and found no more infant deaths among women who planned to give birth at home than those who chose a hospital delivery. Smaller studies conducted in the United States and Canada have also concluded that a properly attended home birth is as safe for mother and baby as a hospital birth.
Still, it’s not for everyone. For one thing, having an epidural or other pain medication is not an option. “We bring no medication for pain,” says Debbie Boucher, a licensed certified nurse-midwife in Libertyville, Ill. However, she says, laboring in your own environment can be a lot easier than in a hospital because you have less stress, more privacy and more control. “Women tolerate labor better and report less anxiety and pain,” she says.
Only healthy women experiencing a low-risk pregnancy should consider planning a home birth. Usually, women are advised against it if they had a chronic health condition (such as diabetes or hypertension) before becoming pregnant; develop complications during pregnancy (such as preeclampsia, gestational diabetes or placenta problems); had a previous C-section and want to deliver vaginally; had a previous preterm delivery; go into labor before 37 weeks or after 42 weeks; are carrying multiples; or if the baby is breech.
However, in select cases, some providers will allow a home birth for twins or a breech baby or after a previous C-section. “All of my moms have to be very healthy,” Boucher says. “I call them obstetrical athletes—they have to be the lowest of the low-risk. People don’t just come in off the street and have a home birth,” she says, adding that many women opt out after they learn what is required of them.
When Complications Occur
Because problems can occur quickly during childbirth, you should look for a midwife who has a lot of home birth experience and access to hospital care. (Many have hospital privileges or work with doctors or other midwives who do.) If a problem that requires hospital technology arises during a home birth, you’ll be transported to a hospital.
This occurs about 12 percent of the time, most often because labor stalls and doesn’t resume after trying such techniques as walking, position changes or eating and drinking. “The transport isn’t usually an emergency with sirens on and lights flashing—it’s usually very calm and slow,” says Alice Bailes, a certified nurse-midwife in Alexandria, Va.
That was the case for Amy Rydell, 37, of Woodland Hills, Calif. After 18 hours of labor and three hours of pushing, Rydell’s midwife advised that they go to the hospital because of some dips in the baby’s heartbeat. Although her midwife didn’t think the baby was in danger, “she would much rather transfer someone than take a risk,” Rydell says. After three more hours of pushing, it became clear that the baby needed help coming out, so the doctor performed a C-section. Her daughter was healthy, but “I felt like I was getting a lot of attitude from the nurses about my choices,” Rydell says.
During a true emergency, there may not be time to get to the hospital, says OB-GYN Erin E. Tracy, M.D., M.P.H., an expert in maternal public health at Massachusetts General Hospital in Boston. Dangerous complications such as umbilical cord prolapse or maternal hemorrhage can develop suddenly. “In some situations you literally have only minutes to have a good outcome,” Tracy says.
To women who choose a home birth, it’s a risk worth taking. “Birth is a very powerful experience,” says Rachael Dadabo. “I felt that being at home allowed that process to unfold in the safest and best way for my body and my baby.”