Read this before saying "no" to a hospital birth.
Let's get right to it: Is it safe to give birth at home? Well, that depends on the mother, her midwife and which studies you read. Two home birth studies have been published recently, giving us lots to talk about. The more recent study, published in The American Journal of Obstetrics & Gynecology, looked at Centers for Disease Control data (almost 14 million births), and concluded that the risk of neonatal death is four times higher with midwife home births than midwife hospital births.
Another study examined data from almost 17,000 women who had planned home births. They found that these women had more vaginal births and fewer interventions, compared to women who had hospital births. The research is published in the Journal of Midwifery & Women's Health.
Confused? What you should know is that the success and safety of any home birth comes down to three essential factors: the right mama-to-be, the right midwife, and an excellent emergency backup plan.
Are you the right fit for a home birth?
You're only a good candidate if...
- You're 100% healthy. You don't have diabetes, high blood pressure, heart disease, an autoimmune disorder or any other health condition that could potentially complicate your birth or your baby's health. Some home birth midwives will deliver women who've had a previous C-section, are obese or are carrying twins, but others won't because these things increase the potential for complications.
- You're certain you won't want pain medicine or an epidural. Having a home birth means an epidural or even IV pain medication isn't possible. Home births are natural births. Always.
- Your partner/husband is supportive of a home birth. If your baby's father is uncomfortable with home birth, or afraid for your and your baby's safety even after he's consulted with your midwife, then choosing a home birth is unfair. This is a huge parenting decision that you should agree on.
- You can afford to pay your midwife out-of-pocket. Insurance providers don't generally cover home births, though they cost a lot less than hospital births.
- You're dedicated to having a normal physiologic birth and willing to work with your body and midwifery team to make that happen. This includes having excellent prenatal care with a qualified midwife. It also means you have a home that can accommodate everything you'll need to have a great birth (being able to eat and drink, walk and rest, change positions, bathe, have privacy and room for your labor support team...whatever it takes to get 'er done).
Do you have the right midwife for a home birth?
You know you've got the right midwife if...
- She's trained, experienced, and licensed. Most home-birth midwives are Certified Registered Nurse Midwives, Certified Professional Midwives, or Certified Midwives. One comes with a nursing background and the others come from other educational backgrounds, but all three have formal midwifery educations, qualify for national certification exams and are licensed. Direct Entry Midwives (a.k.a lay midwives) are trained through self-study and apprenticeships. They may be very skilled and capable, but they're not traditionally trained or licensed. Being certified and licensed doesn't guarantee your midwife (or your doctor, for that matter) knows what she's doing, but it does give her a level of professional credibility.
- She has excellent references. Ask around about your midwife's reputation. Ask if any of her patients would talk to you about their births. Find out if your local hospital has accepted any of her transfer patients and whether those transfers went smoothly.
- She has an obstetrician who backs her up. Emergencies happen, even to the healthiest of mothers. And if something does happen, your midwife needs to have an obstetrician available to take her call. If she doesn't have a solid relationship with an obstetrician for consultations or transfers, she's not the midwife for you.
Do you have an emergency backup plan?
Only choose a home birth if...
- You have an obstetrician at a nearby hospital ready, willing and able to take care of you quickly.
- Your midwife has a plan for how to make an emergency transfer.
- You have a means to get to the hospital.
Remember: Every birth, whether at home or at the hospital, has the potential to turn scary fast. The health and wellbeing of you and your baby may depend on an emergency rescue.