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?
First, 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 tends to work smoothly. 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 "failure to progress" 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%.
(www.mana.org) (www.cdc.gov) (www.who.int)
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 increase the rate and intensity of contractions.
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. Home birth should only be considered if you are healthy and low risk.
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 of us 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 occurs 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. Home birth midwives come equip with the same medicine used at hospitals. They can give you Pitocin after delivering your baby and placenta to help your uterus contract and close the blood vessels. Using Pitocin only after birth is more effective because the woman's receptors have not been saturated with it. Midwives are experienced in handling hemorrhages at home and usually don't need to transfer to a hospital.
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. They will not keep you at home for the sake of having a home birth if you are truly at risk. If there is a true emergency or there is a reason that hospital equipment or a doctor may be needed, they will help you transfer to a hospital. 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. (Click here to learn more about home birth transfers.)
ISN'T IT MESSY?
Home birth is very clean! Bacteria is everywhere, but your home is full of your bacteria while hospitals are full of everybody else's. When choosing a home birth midwife, she provides a list of items to buy before your estimated due date. Some of these items include waterproof sheets/covers, garbage bags, pads, a basin for your placenta. In total, all the supplies you need to get costs around $30-40. Your midwife will set up everything to protect your floors, couches, and bed when she arrives. And they clean up afterward, often leaving your house cleaner than before! (Click here for a great example preparation list.)
Why are families interested in home birth?
Laboring and giving birth at home is an irreplaceable experience. The compassionate, gentle care, and the calm, undisturbed environment is a unique atmosphere for mothers, partners, and babies that you don't find anywhere else.
What you get with home birth care
When planning a home birth, your midwife may come to your home for prenatal visits.
Your 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 that comes up.
Your midwife will usually have an assistant midwife (whom you meet during your prenatal visits) who arrives before baby is born so that you and baby each have your own care attendant.
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 essentially in charge of your birth experience.
After the baby is born, your midwife stays for a couple hours to make sure everyone is settled and support breastfeeding.
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.
Every mother has the right to choose
where she births her baby.
And she should choose to birth
wherever she feels most safe,
secure, and comfortable.
A little history about midwives and birth...
For as long as humans have existed, women have been giving birth out of the hospital. There was a higher rate of infant and maternal deaths due to the lack of medical supplies and technology as well as sanitation. But close to 95% of births were successful.
Hospitals were growing in the 1700-1800's but doctors were not trained to deliver babies in 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 and the view of birth shifted. Women no longer should have to "suffer" and labor should be managed to ensure that it is safe.
Click here for a historical timeline of midwifery and childbirth in America.
Why choose out-of-hospital birth?
Many women who choose to give birth in a hospital experience no complications. However, a great deal of healthy women with low-risk pregnancies who choose to give birth in a hospital 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: free of complication.
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?
Midwives are trained in how to handle emergency situations and how to watch for signs of a possible emergency so that the proper steps can be taken to make sure both mom and baby are safe. They come prepared with a thorough toolkit to manage any type of situation. (Click here for a more detailed list of what's in a midwife's toolkit.)
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 most healthy, low risk moms, it is more risky to be so near an operating room while having their babies, because being in a hospital increases your likelihood of intervention and c-section.
Home birth is not for everyone, and that's ok...
But if it's something you've considered or you're curious about, I recommend you interview one or two home birth midwives. Ask them any questions you have. Share your concerns. You'll get a better idea of how they deal with emergencies and the scope of care that they provide. If you're considering giving birth at a hospital or birth center, interview your hospital midwife or obstetrician. Ask about their c-section rate. Ask about their view on birth.
Every care provider is different. Every family is different. But being informed gives us the power to make the best choice possible for our family.
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
Please share your positive home birth story below!