Home Birth 101: A Beginner's Guide for Parents
Considering giving birth at home? From the benefits and risks to how to get started choosing a midwife, consider this a crash course when it comes to the basics of home birth.
Many parents contemplate home birth because they want to avoid the high-tech atmosphere and medical interventions of a hospital. Others prefer the lower cost, freedom, and ability to spend labor with loved ones. Whatever your initial reason for considering giving birth at home, these facts are the perfect place to start really contemplating if it's right for you.
Who Can Have a Home Birth?
Home birth is usually reserved for women in good health with a low-risk pregnancy. This means you don’t have any chronic medical conditions (such as heart disease or hypertension) or pregnancy complications (like preeclampsia, placenta previa, or gestational diabetes).
The American College of Obstetricians and Gynecologists (ACOG) adds that women shouldn’t deliver at home if they’re carrying multiples (twins, triplets, etc.), having a vaginal birth after C-section, or if the baby is in an improper position (like breech presentation). These types of pregnancies increase the risk of needing medical intervention. Women with preterm labor (less than 36–37 weeks), post-term pregnancy (greater than 41–42 weeks), and advanced maternal age should also opt against home birth.
It’s also smart to steer clear of home birth if you live far away from a hospital. Medical emergencies sometimes arise, and prompt care can save the mother’s or baby’s life. Alternatively, you can choose to go to a friend's or relative's house that’s closer to an emergency center.
The Benefits of Home Birth
Studies have linked home birth with a decreased risk for maternal interventions. According to the ACOG, these include “labor induction or augmentation, regional analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery.”
Here are a few more benefits of giving birth at home:
- Fewer maternal infections
- Lowered risk of third-degree or fourth-degree vaginal or perineal tears
- Ability to be surrounded by family and friends
- Freedom to do almost anything you want, including walk around, take a shower, cook food, watch TV, etc.
- More control over birth decisions
- Lower cost
- Increased bonding with the baby
- More privacy
The Risks of Home Birth to Consider
According to the ACOG, home birth “is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).” Even if there's a sound emergency plan in place, you could lose valuable time in transit to the hospital.
When it comes to the possibility of needing to go to a hospital, your chances are high if this is your first home birth. Around 23 to 37 percent of first-time parents attempting home birth end up transferring to the hospital. “Most of these intrapartum transports are for lack of progress in labor, nonreassuring fetal status, need for pain relief, hypertension, bleeding, and fetal malposition,” says the ACOG.
Women who delivered at home were also more likely to experience problems such as postpartum hemorrhage and prolonged labor. There's also less options for controlling labor pain which is a something first-time parents may overlook.
How to Choose a Midwife
The most common professional parents hire to assist in a home birth is a certified professional midwife who comes with tools, training, and expertise. When interviewing candidates, ask how many births they've attended, both as a primary (where they were in charge) and as an assistant. You want someone who's been the primary birth attendant in at least 100 births, says Chris Ann Beard, a certified nurse-midwife in Portland, Oregon. Make sure the midwife works with an assistant as well (most do).
Also, make sure the practitioner is comfortable handling emergencies. Ask specific questions about the range of complications she's handled. She should have the knowledge and equipment necessary to resuscitate a newborn, administer medication to stop a postpartum hemorrhage, and suture a severe laceration. In case of such emergencies, she should bring IV fluids, an oxygen tank, and oxygen masks for various sizes of infants. She should also tote an oxygen delivery device suitable for adults (in case you need one) as well as suturing materials.
To find a midwife who does home births, log on to mana.org, the website of the Midwives Alliance of North America. Word of mouth can also be a good method.
Home Births and the Hospital
It’s important to note that some birth patients sometimes have all of their prenatal lab work and ultrasounds done through a doctor's office, often on the midwife's recommendation. That way their insurance is put to some use. And if the patient ends up being transferred to the hospital, the medical records are already on file.
Ideally, your midwife should have a relationship with a physician or hospital in case the home birth doesn't go as planned. If she doesn't have a doctor she can call to describe what's happened and warn of your arrival, you'll basically be treated as an ER patient, notes Beard. The doctor and staff won't know anything about your medical history, and they will likely be very worried about you and your baby. This often results in more tests and interventions—the very thing many women want to avoid.
Here are some common reasons home birth patients end up at the hospital: