Today only about 1.5% of births in the United States take place outside of the hospital. But more and more women are becoming interested in giving birth at home. Why is this? And is it really safe?
When thinking about home birth, the biggest question seems to be, "What if something goes wrong?" But, do you even know what actually could go wrong and how it's dealt with?
Let's address some of the biggest concerns about home birth...
Is it safe?
For a healthy mom and baby, there is a very low risk of serious complications in home birth. Research shows that, when you feel safe and don't mess with the natural birth process, it actually makes birth safer.
89.1% of people who plan for a homebirth are successful. For the roughly 21% of people who end up transferring from home to hospital, the most common reason is a long labor and exhausted mother rather than an emergency. The rate of infant mortality in home births is around 0.17% and maternal mortality even less. In hospitals, the infant mortality rate is closer to 0.59% and maternal mortality rate closer to 0.2%.
What if my uterus ruptures?
Uterine rupture is extremely rare, occurring in less than 1% of women according to vbac.com. In the small group of women who do experience a uterine rupture, it is more likely to occur in a hospital from the use of medication that increases the rate and intensity of contractions. When a uterine rupture does occur, 90% of the time it ends well, with a repaired uterus and a healthy mother and child.
What if I have placenta abruption?
Placenta abruption is also extremely rare, occurring in 1% of women according to americanpregnancy.org. In the small group of women who do experience placenta abruption, they have usually already been diagnosed as high risk due to high blood pressure or some other condition. If this is occurring at home, you would be alarmed by the heavy amount of bleeding and simply go to the hospital.
What if the cord is wrapped around the baby's neck?
Approximately 1 out of every 3 babies is born with the cord wrapped around their neck, and its not as big of a deal as most people think. When a baby is in the womb, they are not breathing with their lungs; they are receiving all their oxygen through the placenta. Their bodies don't switch to breathing air until a series of events occur within their body as they're exposed to gravity for the first time. To learn more about this transition that babies make, click here.
What if I hemorrhage?
Hemorrhage occurs in 1-5% of women, and is usually related to cesarean section. The best way to prevent a hemorrhage to have an undisturbed, physiological birth and 3rd stage (birth of placenta). Bleeding after birth is normal, and if it's enough that you feel faint or your midwife is concerned, there are a few things you can do before adding medicine to the mix: get horizontal in bed, hydrate, eat something, and start breastfeeding your baby. Placentas usually come out within the first 5-20 minutes, but sometimes they take longer and that's ok. The only person that should be pulling your placenta out of your body is YOU.
Home birth midwives come equip with the same medicine used at hospitals to prevent hemorrhage, Pitocin. They can administer this drug via a shot in your leg after your baby is born in order to help your uterus contract, detach the placenta and close blood vessels. Using Pitocin only after birth is more effective because the oxytocin receptors in the uterus have not been saturated with it. Midwives are experienced in handling hemorrhages at home and usually don't need to transfer to a hospital. In addition, they can administer an IV, provide herbs that cause uterine contractions, give fundal massage, and even make a smoothie using part of your placenta.
What if there is an emergency and the paramedics don't make it in time?
It is very, very rare (less than 1%) that home births require emergency transfer. The vast majority of the time when midwives see a complication, they can correct it early, and if they can't, there is enough time to get to the hospital. First and foremost, midwives want you to be safe. If there is a true emergency or there is a reason that hospital equipment or a doctor may be needed, they should help you transfer to a hospital and remain with you there. Midwives come prepared with a medical kit to manage complicated situations. (Click here for a more detailed list of what's in a midwife's toolkit.)
The most common reasons to transfer include baby being stuck in a funky position, signs of stress on baby, and very long or abnormally progressing labor. Most of the time, these are just variations of normal and can be handled at home by simply being patient and moving positions. (Click here to learn more about home birth transfers.)
Once in a blue moon, there is a maternal or fetal death at home, just as there are at hospitals. Being farther away from an operating room is one of the risks of choosing home birth. However, for many women, it is more risky to be so near an operating room because being in a hospital increases your likelihood of intervention and c-section.
Isn't it messy?
Yes and no. Birth is messy, no matter where you are. There's blood, poop, sweat, and all kind of fluids. But germs are a different story. Bacteria is everywhere, but your home is full of your bacteria while hospitals are full of everybody else's.
When planning a home birth, you can prepare to have a bunch of useful items handy, including: lots of towels, waterproof mattress cover (or some people use shower curtain), garbage bags, waterproof pads, a bowl for your placenta. In total, all the supplies you need to get costs around $30-40; maybe a little more if you buy or rent a birth tub. Your midwife or support team can set everything up to protect your floors, couches, and bed. And they clean up afterward, often leaving your house cleaner than before! (Click here for a great example preparation list.)
Why choose home birth?
“An unmedicated birth in an environment where a woman feels comfortable, where she’s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is a physiological birth. And once you start messing with any one of those factors, put her in a hospital with noise and light, take away her privacy, you go down a slippery slope toward industrial birth.” - Pushed, by Jennifer Block
Many women who choose to give birth in a hospital experience no complications. However, a great deal of women end up having un-necessary interventions that often lead to complications and cesarean section. Statistics show that there is a lower rate of interventions in home birth and better birth outcomes including healthier babies and breastfeeding success.
When labor is undisturbed, when a woman is feeling safe and supported, her hormones keep labor flowing and birth is more likely to happen the way it's designed to: safely.
This is part of the reason hospitals want you to labor at home as long as possible before coming anyway!
For more information about home birth safety, listen to episode 42 of the Healthy Births, Happy Babies Podcast: Is a Home Birth with a Midwife Right for You?
A Few Benefits of Home Birth
Midwives often come to your home for prenatal visits.
Prenatal visits are longer and more intimate than hospital appointments so you get really comfortable with each other and have time to talk about anything.
You can labor at your own pace, eat and drink as you please, and birth in any position that feels best (even in water!). You are in charge of your birth experience.
You are in your own familiar, cozy space where you can relax.
Your body and your birth are treated as healthy and integral rather than as a medical emergency.
Undisturbed birthing hormones allow you to cope with the sensations of birth, give you the most blissful feelings of your life, make birth safer, and support successful breastfeeding and bonding.
Your midwife stays for a couple hours after birth to cook you a meal, support breastfeeding, throw in a load of laundry, and tuck you into bed.
What's really unique and special about home birth midwives is that they visit your home for days and weeks after the birth to support the transition of having a new baby.
Remember, we are alive today because all of our ancestors survived home birth
For as long as humans have existed, women have been giving birth at home. Hospitals only began growing in the 1700-1800's but doctors were not trained to deliver babies at that time. Midwives were the primary care providers for women having babies. And even by the year 1900, only 5% of births took place in a hospital. Gradually, trust was handed over to doctors as women were not allowed to support each other in birth anymore, and the view of birth shifted. Women no longer should have to "suffer" and labor should be managed to ensure that it is safe and efficient.
Click here to read more about the history of childbirth and how it came to be viewed with so much fear.
Choose the birth setting and care provider that fit into your ideal vision for birth, not the other way around
Care providers are not interchangeable; no two are the same. Most serve with a heart of true passion and care; some serve solely with a wallet to fill or ego to boost. A licensed midwife or doctor does NOT mean a well-trained and educated one. More often than not, a license only limits how they can serve you. You may want a care provider who is there to serve YOU, not serving the state or medicalized model of birth. Or at least to know where on that spectrum you both stand.
If you're on the fence about home birth, interview a few midwives and get all your questions answered. Feel them out and see if anyone would be a good fit.
If you still feel safer birthing in a hospital, also interview the care providers there!
Read my home birth story
Noah's Gentle Birth (video)
Jinti Fell's Home Birth (video)
Birthful Podcast Episode #11 - Why an obstetrician chose a home birth
Healthy Births, Happy Babies Podcast Episode #42 - Is a Home Birth with a Midwife Right for You?
Midwife's toolkit for home birth
Home birth supplies list
Home to hospital transfer information
Healthy Births, Happy Babies Podcast Episode #60 - Pregnancy is NOT a Disease that Needs to be Treated Medically
Healthy Births, Happy Babies Podcast Episode #63 - The Beauty of Waterbirth
What Mothers Have to Say...
"I was able to have an HBAC (home birth after cesarean) and there were many people that would not have let me have a natural birth due to spacing and previous gestational problems. My first pregnancy ended in an emergency c-section at 34 weeks due to severe preeclampsia, and 4 months later we discovered that we were expecting again. There were no doctors in our state that would have let me deliver naturally so we immediately started searching for a midwife that would work with us. We found a highly qualified midwife that was willing to monitor me closely throughout pregnancy to watch for signs of preeclampsia and we trusted we would transfer only if absolutely necessary. We were able to deliver our second girl at home 12 days after due date with no complications."
- Anonymous Badass Mama
"I am skeptical of hospital birth as the environment lead me to receiving unnecessary interventions, interventions that gave me PTSD. My labor slows down in the bright lights, lack of privacy and the medical staff's lack of trust in my ability to give birth. I just can't give birth publicly. My labor stalls and I have ended up with cesareans because the environment sent me into "fight/flight" syndrome.
When I chose later to give birth at home, (3x) is has always gone smoothly without any problems. I need privacy, dark and trusting support people. I need familiarity.
So I am skeptical of hospital birth - for me.
However, for over a century a culture of fear of childbirth has grown to epic proportions. If someone is afraid of birth, has been raised to not trust her body, and the thought of giving birth at home gives her severe anxiety, she should probably not give birth at home. She should be skeptical - for herself."
- Anonymous Badass Mama
If you'd like to share your home birth story on our blog, please send me an email.