Home Birth 101: Everything You Need to Know

Think you absolutely need to get yourself to a hospital when you go into labor? According to some home birth experts, this might not always be the case.

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Home births might seem like risky moves favored only by the hippy-dippy set, but according to a recent study from researchers at the University of Oregon Health & Science University, women who give birth at home might be at one particular advantage: They're more likely to give birth naturally and vaginally. And while home births are not without risks, they're also probably nothing to fear.

"People likely have a variety of reasons for fearing either hospital or home births. One strength of our study is that it offers more specific information to women and their families about the risks and benefits they may encounter in each setting. This information can be used as women explore the evidence related to their options and make choices about which risks they prefer to accept and which they prefer to avoid," Jonathan Snowden, Ph.D, and Ellen Tilden, Ph.D, the study's lead author and co-author, respectively, told Fit Pregnancy.

The researchers studied birth certificates in Oregon, taking birth setting into account. "Women's risk for cesarean delivery—if they choose a hospital birth—has changed a great deal over the last 20 years," Snowden and Tilden said.

The risks of a hospital birth

One major finding was that women who give birth in hospitals are understandably much more likely to undergo C-sections. "Cesarean delivery is much more common now than it was in the mid '90s but this increase in cesarean delivery has not led to better outcomes for moms and babies in our country, in fact our outcomes are getting worse. Importantly, we should be concerned about C-sections because this method of delivery is associated with higher risk for a woman. This risk is both immediate, such as risk from an infection due to surgery, but is also long term. Several studies have shown that every time a woman has a C-section, her risk is increased for having serious problems in future pregnancies with how and where her placenta grows. For these reasons, it is important that we successfully navigate the delicate balance between risks to a woman and risks to her child with each delivery. This is why we should strive for a U.S. maternity care system that both minimizes risks to the baby in out-of-hospital settings by decreasing perinatal mortality as well as minimizes risks to the woman in in-hospital settings by safely reducing cesarean delivery."

The risks of a home birth

But that doesn't mean that there are no risks associated with home births. "There is a small but statistically significant increase in risk for adverse baby outcomes, specifically perinatal mortality [stillbirth or early death] and neonatal seizures. Conversely, women who have a baby in a hospital setting are much more likely to receive obstetric interventions such as cesareans, induction of labor, or an epidural," Dr. Snowden and Dr. Tilden said. "The question of if home birth is a 'smarter' option than hospital birth cannot be addressed by our research."

It might go without saying, but the possibility of choosing a home birth is something you should discuss with a doctor first. If you have a high-risk pregnancy, it might not be the way to go. "A woman preparing for a home birth may wish to have a direct conversation with her maternity care providers regarding subjects such as what birth may be like in a non-clinical setting, what skills she may wish to cultivate as she prepares, and how transfer to the hospital will be managed if necessary," Dr. Snowden and Dr. Tilden added.

Having a 'smarter' home birth

While risks exist for home births, the researchers said there are a few key improvements that can make it much safer in the the future. More highly educated midwives, improved communication between in-hospital and out-of-hospital care providers, clear guidelines as to which women are good candidates for home birth, and improved communication between physicians and midwives are a few, according to Dr. Showden and Dr. Tilden.

The best piece of advice we can give you about home birth? Be sure it's the right choice for you. The researches echoed this sentiment, saying: "The assessment of risk is complicated and is a very personal choice for a lot of women. The increased risk for perinatal death is something that may drive some women's decision on their planned birth setting. For other women, the increased risk of cesarean or obstetric procedures may be factored into their determination of risk as strongly. Women and their families are the ultimate decision-makers about why home birth may or may not be a 'smarter' option for them."

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