Your Guide to Giving Birth at Home

More and more pregnant people are considering home birth, a practice that for centuries was the way people gave birth. Today, many parents contemplate home birth because they want to avoid a hospital's high-tech atmosphere and medical interventions, such as drugs to speed labor or having an epidural to relieve pain. Others prefer the lower cost, freedom, and ability to spend labor with loved ones comfortably at home. Home birth is also sometimes called free birth or unassisted birth.

While there are important risks to consider, home birth is a valid, legal option for those who are good candidates. Home birth is an especially good fit for those with low-risk pregnancies, particularly if they have given birth before. 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 healthy people with uncomplicated pregnancies. 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). So, unfortunately, if your pregnancy is categorized as high-risk, you'll likely need to give birth at a hospital.

The American College of Obstetricians and Gynecologists (ACOG) guidelines state the following conditions are also not considered safe for home birth:

• Absence of a certified nurse–midwife and certified midwife 
• Advanced maternal age (typically defined as 35 years or older)
• Carrying multiples (being pregnant with more than one fetus)
• Vaginal birth after a C-section (VBAC)
• Inability to get a timely transfer to a hospital, if needed
• Preterm labor (less than 36 to 37 weeks)
  
• Post-term pregnancy (greater than 41 to 42 weeks)
• The baby is in a less-than-optimal position (like breech presentation)

According to the ACOG: "The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth."

These types of pregnancies increase the risk of needing medical intervention. It's also smart to steer clear of home birth if you live far away from a hospital. Medical emergencies sometimes arise, often unexpectedly, and prompt care can save the pregnant person's or baby's life. Alternatively, you can choose to give birth at a birthing center or 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:

• Ability to be surrounded by more family and friends than typically allowed in hospitals
• Encourages establishing breastfeeding practice
• Fewer maternal infections
• Freedom to do almost anything you want, including being in your own home, walking around, showering, cooking food, watching TV, etc.
• Increased bonding time with the baby
  
• Lower cost
• Lowered risk of third-degree or fourth-degree vaginal or perineal tears
  
• More privacy
• More control over birth decisions

While every birth is unique, studies have found that people who have a planned home birth often report high levels of satisfaction with their birth experience.

People often wonder if having a baby at home makes for a less painful birth. This is very difficult to determine as each person experiences pain differently—and it's impossible to know how their pain sensation might have changed in a different environment. However, for some people, the comfort of being at home may help them to cope with pain more effectively.

The Risks of Home Birth

In many cases, home births are successful, but occasionally, complications arise. According to the ACOG, home birth is "associated with a more than twofold increased risk of perinatal death (1 to 2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4 to 0.6 in 1,000)." Even if a sound emergency plan is in place, it's important to consider that you could lose valuable time in transit to the hospital if your birth doesn't go as planned. In other words, you won't have immediate access to emergency medical care should you need it.

If this is your first birth, the possibility of needing to go to a hospital is much higher than for pregnant people who already have kids. Around 23% to 37% of first-time parents attempting home birth end up transferring to the hospital compared with 4% to 9% of those who have given birth before. "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.

Birthing parents who delivered at home were also more likely to experience problems such as postpartum hemorrhage and prolonged labor. There are also fewer options for controlling labor pain, an issue that first-time parents may not fully appreciate when planning their home birth.

Preparing for a Home Birth

Consider both the potential benefits and risks of home birth and how they apply to you. An OB-GYN or midwife can help you with this decision. Once you know that home birth is right for you, it's time to make all the necessary preparations.

Choose a midwife

The most common professional parents hire to assist in home birth is a certified 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. Chris Ann Beard, a certified nurse-midwife in Portland, Oregon, says you want someone who's been the primary birth attendant in at least 100 births. Ask if the midwife works with an assistant (most do).

Also, make sure the practitioner is comfortable handling emergencies. Ask specific questions about the range of complications they've handled. Your midwife 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, your midwife should bring IV fluids, an oxygen tank, and oxygen masks for various sizes of infants. They should also tote an oxygen delivery device suitable for adults (in case you need one) and suturing materials.

To find a midwife who does home births, check out the Midwives Alliance of North America website. Word of mouth can also be a good method for finding a trusted midwife.

Get acquainted with a hospital

Some home birth patients have all of their prenatal lab work and ultrasounds completed through a doctor's office, often coordinated with an OB-GYN affiliated with their midwife. That way, their insurance is put to use, and if the patient is transferred to the hospital, their medical records are already on file.

Ideally, your midwife should also have a relationship with a physician or hospital. That way, if the home birth doesn't go as planned, your care at the hospital will be more streamlined. If your midwife doesn't have a doctor they work with, they can call to describe what's happened and warn of your arrival, but you'll basically be treated as an ER patient, notes Beard.

The doctor and staff won't know anything about your medical history and will likely have concerns about you and your baby. This often results in more tests and interventions—the very thing many birthing parents hoping for a home birth want to avoid.

Create a birth plan

Think about what your preferences are for your birth and write them up in a birth plan. This plan offers a guide to your birth preferences and helps those supporting you to know your wishes. This is especially important because, during the throes of labor, you may not be able or inclined to explain your preferences. Writing the document also becomes a vehicle for discussion and reflection. You'll want to consider each element of the birth, including the following:

• Do you want to record your birth?
• Do you want to use your tub?
• How mobile would you prefer to be?
• How will you feed your baby?
• How will you get to the hospital (and which one), if needed?
• If breastfeeding or chestfeeding, when will you start?
• When you will consider pain relief and what kinds do you want to try?
• Who would you like to cut the umbilical cord (and when)?
• Which birthing positions would you like to use?
• Which room or rooms you would like to labor in?
• Who you would like to be present?
• Would you like music to be played?
  

Go over your birth plan with your medical provider. They can help you adapt your plan, as needed, to your specific situation. Then, everyone will be on the same page when the big event happens.

Gather necessary supplies

Since you won't be at a hospital, you'll need to make sure you have everything on hand that you'll need for the birth. Check with your midwife to confirm what they suggest you have at the ready. They also may bring some of the supplies you'll need. However, a basic list includes the following:

• Baby supplies, such as baby wipes, newborn diapers, and newborn clothing
• Bucket (in case you throw up)
• Ice chips
• Ice packs
• Light, easily digestible snacks, such as popsicles, clear broth, and toast
• Loose, comfortable clothing
• Over-the-counter anti-nausea medication and pain medication, such as ibuprofen or acetaminophen
• Overnight menstrual pads
• Pillows (and waterproof pillow covers)
• Towels, in a variety of sizes
• Water bottle
• Waterproof pad or plastic sheet (to protect your mattress or wherever you labor)
  

Why Some People End Up at the Hospital

Often home births go as planned, particularly for people who have low-risk pregnancies. However, there are a variety of issues that will preclude you from attempting or continuing a home birth, most of which are out of your control.

Here are some common reasons home birth patients end up at the hospital during or after birth:

• A breech presentation or other difficult birthing position
• Fetal distress
• Labor that isn't progressing
• Maternal hemorrhage (excessive bleeding)
• Maternal high blood pressure
  
• Need for epidural or pain medication