Is Home Birth For You?

Long before there were hospitals to deliver in (and even long after hospitals started to spring up), women were having babies at home — often in the same bed they themselves were born in. But with the unsanitary conditions and haphazard medical care that were the norm a couple hundred years ago, it was hardly an ideal way to give birth.

Home birth is a common occurrence for women in some countries, such as the United Kingdom and the Netherlands. However, in the U.S., home births are rare and actively discouraged by many obstetricians, including the American Congress of Obstetricians and Gynecologists. Although U.S. home births have increased by 30% in the past few years, less than 1% of American women give birth at home (MacDorman et al., 2012). This means that for every 100 of your friends and family members who get pregnant and have a baby, 99 of them will birth in the hospital.

But the natural birth movement has become increasingly popular lately, with a whole new kind of home birth seeing a bump in popularity over the past decade.

Modern home birth can be safe and successful, particularly if moms-to-be have excellent support and if they’ve prepared themselves thoroughly with childbirth education classes. In fact, midwives say that a planned home birth for low-risk women with adequate prenatal care and a qualified attendant is as safe as a hospital birth. For expectant mamas who are wary of hospital protocols and personnel, it’s easy to see the appeal: No place beats home for a comfy, cozy and peaceful delivery, with your baby’s arrival heralded by family members and friends who might not be allowed in a hospital delivery room.

Is a home birth right for you?

The topic of home birth can be polarizing. On the one hand, some professional organizations, including the American College of Obstetricians and Gynecologists (ACOG), are cautious about recommending it. ACOG says that while hospitals and birthing centers are the safest place to give birth, moms should have the option to give birth at home — as long as they are fully educated on its risks and benefits, especially the increased risk of neonatal death. Yet other medical professionals, like the American College of Nurse-Midwives (ACNM), strongly support home birth and say it’s a very safe alternative to a hospital birth.

Experts do agree, however, that not everyone is a good candidate for home birth. According to the ACNM and ACOG, you might be a candidate for a home birth if you meet these guidelines:

  • Your pregnancy has been low-risk. That means you’ve had no evidence of hypertensiondiabetes or other chronic medical conditions. You also haven’t developed any pregnancy complications, like gestational diabetes or preeclampsia, and you’re not at risk of preterm birth. Likewise, you should have no history of a previous C-section, because there’s a (very) low risk of uterine rupture with VBAC (vaginal delivery after C-section) — making it safer to deliver in a hospital or birthing center in case of complications. On that note, if you’ve had complications in previous pregnancies, you might be more likely to have complications this time around, making a hospital or birthing center your safest option.
  • Your home birth will be attended by a physician or certified nurse-midwife. If you opt for a midwife, a consulting physician should be on call, preferably one who has seen you during your pregnancy and has previously worked with the midwife.
  • You have transportation available and live close to a hospital. This way if an unexpected emergency arises and you need advanced medical assistance to protect your life or your baby’s, it’s a relatively quick drive away.

Additionally, ACOG suggests you attempt a home birth only if:

  • You’re only carrying one baby. Multiple births have more variables — and more surprises — than single births. Because epidurals are strongly encouraged (or even required) for moms delivering multiples, you’ll need to head to the hospital. Plus, following the delivery of your first baby, you might need intervention only available at a hospital, such as a vacuum extraction, to get the second out safely.
  • Your delivery is perfectly timed. That means you go into labor between 37 and 41 weeks. Any earlier or later, and you should head to the hospital, as preterm babies born before 37 weeks often need at least a few days’ stay in a hospital’s neonatal intensive care unit (NICU), and late arrivals — usually larger, with a wider head circumference — more often need to be delivered by cesarean section to make a safe arrival.
  • The baby is properly positioned for a vaginal delivery. That is, head down. Breech babies (those positioned feet- or butt-first) require extra assistance during birth and possibly require C-section to protect the baby and the mother’s life.
  • Your labor is spontaneous or you were induced as an outpatient. If you’re admitted to a hospital, stay put and see your delivery though there.

The Benefits

No birth situation offers the mother-to-be as much control as one at home. A few of the biggest benefits:

  • It’s at home. You have your bed (or a birthing tub or spa), your things, your kitchen (with food you’re allowed to eat) and your bathroom.
  • It’s your way. There’s no nurse telling you that you need to lie down, no endless parade of hospital staff to bother you night and day (or poke their heads and fingers into your private parts when you’d rather keep them private).
  • There are potential health benefits. Planned home births have been associated with less maternal infection, fewer maternal interventions (including electronic fetal heart rate monitoring and episiotomy — though they’re very rare these days) and fewer third- or fourth-degree lacerations and tears.
  • It may cost less. A planned home birth might also be the most economic option, as home births cost about one-third as much as hospital births cost before you factor in insurance coverage.

The Risks

Among these positives, however, it’s important to note that there are some downsides:

  • You may not have as many options for pain control. If there’s any chance you might want an epidural or other anesthetic pain meds, you won’t be able to order those at home. So it’s important to consider your pain threshold — and whether you think there’s a chance having the option of an epidural might be comforting to you.
  • You may end up at the hospital anyway. The risk of needing hospital transport is relatively high with home birth: If it’s your first pregnancy, there’s a 25 to 37 percent chance you’ll need to be transferred to the hospital mid-labor. Transports occur for a variety of reasons, including a lack of progress in labor, non-reassuring fetal status (or fetal distress), need for pain relief, hypertension, bleeding and fetal malposition.
  • There’s an increased risk of perinatal death. According to ACOG, planned home births are more than twice as likely to result in perinatal death (babies who die during or shortly after birth) than planned hospital births — though the risks are still low, at one to two in 1,000.

The Next Steps

Home birth is not for everyone, but it is an option for low-risk women who want to avoid medical interventions, want to have an active role in giving birth, want to have options of different positions while giving birth, do not want to be separated from the baby in the hours after childbirth, and want to be in a familiar environment surrounded by loved ones. Giving birth, whether at home or in a hospital, comes with risks and therefore it is also important to do your own research on home birth. Here are some tips to consider:

  • Talk to your obstetrician and/or doctor
  • If you want a midwife, interview midwives about their birthing philosophies and experiences to find a midwife that you are comfortable with and respects your views on birth.
  • Have a “plan b” just in case you need to be transfer to the hospital
  • Find a pediatrician that will be available to examine your baby right after birth

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