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Born at Home
For some parents, the idea of planning to have their baby born at home feels natural and normal; for others, especially in high-tech countries, the idea of a home birth may feel frightening and unnecessarily risky. Conflicting medical opinion has made the truth of the situation murkier, with the American Public Health Association encouraging more babies to be born at home, and the American College of Obstetricians and Gynecologists opposing it. To help move beyond emotions to a clear-eyed view of the risks and benefits of home births, researchers looked at what happened to the babies of all of the women in the United States and Canada with due dates in the year 2000 who engaged the services of a certified professional midwife for a planned home birth. The results of this study of 5418 women and their babies were published in the June 18, 2005 British Medical Journal. These results were compared to babies born in hospitals that same year. Losing a baby is a tragedy. For women with low risk pregnancies, the actual mortality rate of the babies planned to deliver at home was low at 0.17 percent – about the same as for low risk pregnancies delivered in hospitals. The maternal mortality rate at home was 0. One of the big differences between home and hospital births was in medical interventions. At home, 2 percent of women received episiotomies, compared with 33 percent in hospitals; about 1 in 200 deliveries used vacuums at home, compared to more than 1 in 20 in hospitals; and the C-section rate was less than 1 in 25 for those who planned to deliver at home, compared to almost 1 in 5 for those who planned their deliveries in hospitals.
Of course, the C-sections weren’t performed at home. At some point after labor began, about 12 percent of the women who planned to deliver at home ended up being transferred to a hospital. The midwife considered the transfer urgent for either the mother or the baby in about 3.4 percent of deliveries. To me, one of the key things to weigh when considering a home birth for a low risk pregnancy is the speed and level of expertise at which state-of-the-art emergency support is available if needed. In this situation, each minute is precious. I would like to see the implications of urgent transfers studied more closely.
However, for more than 96 percent of planned home deliveries of low risk pregnancies, emergency care never became an issue. For most, the home was turned into the peaceful place where the baby first met the world, the cord was cut, and the baby first nursed at her mother’s breast. More than two thirds of the financial costs were saved, many interventions were avoided, and there was no added mortality risk.
Click here to hear the audio of this article.
Alan Greene, M.D., F.A.A.P.
Reviewed by Alan Greene MD FAAP December 2005
June 21, 2005 | Permalink
Comments
I agree wholeheartedly with Katya. My first daughter was born at home -- all 9 - 1/2 pounds of her -- and it was beautiful. My second daughter was born in the hospital, a homebirth transfer, after 6 hours of pushing with no progress and failing contractions. I can verify that a homebirth and hospital birth are veeeerrry different experiences. Although I was surprised and pleased that I was "allowed" to push for several more hours to birth her, there were many negative things the hospital staff did, and many hospital "policies" that were unnecessary and intrusive. I was depressed for months after my second daughter's birth, something that never happened with my first daughter. Every woman should be informed about the possibility, safety and empowering beauty of homebirth and it should be covered by every insurance plan that covers hospital birth. This would save insurance companies and taxpayers millions of dollars every year, and start new mothers, babies and fathers on the road to being a family in the healthiest and most joyous way possible.
Posted by: Lisa | Mar 12, 2007 11:28:23 PM
i was born at home in UK been ill since then ! do midwives do screening for congenital illnesses etc?
Posted by: nadia | Apr 30, 2006 2:19:01 AM
I am currently 32 weeks pregnant and planning my 3rd home birth, this time in water. It's all about faith and fear and what you wish to invest your energy into. I am considered a high risk due to RH incompatibility, but my titers are low and I feel fabulous. I encourage women to find their strength and ask for what they need (whether at home, or in the hospital). Home birth is not for every women, but for those who choose it, they usually reflect on the empowerment and connectedness of their experience.
In Faith,
Autumn
Posted by: Autumn | Jul 18, 2005 7:57:39 PM
Dr. Greene,
You might be interested in reading this study:
http://www.scienceblog.com/cms/node/8293
:-)
Katya
Posted by: Katya | Jul 1, 2005 12:39:53 PM
Thank you for sharing this study. I will in turn share this with my doula group.
Posted by: Katya | Jun 29, 2005 7:56:49 PM
I know many of these dedicated midwives who worked diligently on this prospective sudy. I congratulate them on the fruits of their labor. My first son was born in the hospital and it was a nightmare. My second, my daughter was born at home and it was a dream come true. I gave birth in a tub and pushed her out into my own hands with my midwives attentively watching but not interfering. Bliss!
To the mom who endured a birth complicated with a prolapsed cord: your baby would not have necessarily died had you been planning a homebirth. Prolapsed cords do happen at home with good outcomes. The midwife simply pushes the baby's head up off of the cord and holds that position during transport and right into the surgical suite for the c-section. American medical professionals would have you beleive that their "expertise" is necessary to ensure safe deliveries. Unfortunately, more often than not, their meddling causes harm to mother or baby. And the complications they try to scare you with can be dealt with effetively and safely in a homebirth situation through skilled midwifery and/or timely transport.
Let's bring birth to a new level of safety and joy. Midwives handle normal births at home transporting to skilled obstetricians and pediatricians when their expertise is required. This will improve outcomes, restore happy birthing, reduce healthcare costs and allow midwives and doctor's to each do what they do best, respectively.
Posted by: Laura | Jun 27, 2005 7:28:49 PM
I had a very low risk pregnancy with both my children. My daughter was born naturally in hospital with no complications. But, with my son (2nd child) I had a prolapse cord and had to have an emergency ceasar. If I had not been at the hospital already, he would not have made it. I was grateful that I had chosen to birth him in a hospital!
Posted by: Cara Mullin | Jun 27, 2005 2:26:31 PM
Excellent article..... We got pregnant naturally and gave birth at home on the couch at age 45 with certified nurse midwives ....my first child....best choice I ever made.
Posted by: Lisa | Jun 24, 2005 8:45:25 PM
