Home Birth: Everything Parents Need to Know
Home birth is gaining popularity in the United States, but it’s often misunderstood. These facts shed some light on the cost, process, and experience of giving birth at home.
Although the number of women who give birth at home is small (less than 1 percent), home birth has certainly gained attention in recent years. Yet it’s often misunderstood, rife with stereotypes like doctor-hating hippie parents and chanting, incense-waving midwives. If you're curious about what home birth is really like, these facts might shed some light on the model, the process, and the experience of giving birth at home.
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.
Benefits 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. Here are some of the benefits of giving birth at home:
- 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.”
- 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
Risks of Home Birth
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. Women who delivered at home were more likely to experience problems such as postpartum hemorrhage and prolonged labor.
Other risks of home birth include:
- Possible transfer to a hospital. 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.
- Less options for controlling labor pain
- Insurance may not cover home birth
How Do I Choose a Midwife?
It's extremely unlikely that you'll find an OB-GYN to be your home birth attendant, since they're taught to treat birth as a medical event with potential complications. Instead, you’ll probably hire a certified professional midwife who comes with tools, training, and expertise. Other options include naturopathic physicians and direct-entry midwives.
When interviewing candidates, ask how many births she's attended, both as a primary (where she was 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 (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.
Most midwives will already have this medical supplies on hand. Marinah Farrell, a certified professional midwife (CPM) in Arizona and the current president of the Midwives Alliance of North America explains: "Standard of care for midwives for emergencies includes pharmaceuticals—such as Pitocin or synthetic oxytocin for use in case of hemorrhage, oxygen, IVs, equipment necessary to monitor and record vitals on both mother and baby, and other first aid type equipment. Midwives also carry instruments and have the ability/training to suture and administer medications to the newborn, such as eye ointment and vitamin K, or to the mother, such as Rhogam. Essentially, midwives are trained in the use of standard birth supplies.”
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.
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.
What If Something Goes Wrong?
Planned home births that turn into hospital births are more common than you think, and not always because of a sudden emergency. Lawrence Leeman, M.D., co-director of the mother-baby unit at the University of New Mexico Hospital in Albuquerque, New Mexico, explains: "I think that one of the most common misconceptions is that transfers that occur from home birth are emergency transfers. Prolonged labor at home without progress, the bag of waters broken for an extended period of time...these are more common reasons for home birth transfers. Most of the births wind up in normal vaginal deliveries, maybe needing some synthetic oxytocin to make the contractions stronger or more frequent."
Of course, that doesn't mean that serious situations can't and won't occur at home. But that's all the more reason to have a well-thought-out backup plan. Dr. Leeman adds that it's vital to have close access to a hospital in case you end up needing more medical care: "It's essential for home births to have a safe hospital to transfer to. It's not safe to plan a home birth where you or your care provider are not willing to transfer to a hospital."
It’s also 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.
Here are some common reasons home birth patients end up at the hospital:
Do I Need a Home Water Birth?
The modern image of home birth—just search "home birth videos" on YouTube, for many examples—is often of a woman squatting in an inflatable pool in her bedroom or living room, pushing her baby out into water. But not all home births are water births!
It's nice to have the option, of course, but it's certainly not required. One of the large bonuses of having a home birth is being able to labor and birth wherever you feel comfortable—if that's your bathtub, your couch, your bed, or another location in your home.
Are Home Births Messy?
The ick factor can be a source of hesitation for families interested in home birth. You might have visions of your partner fainting at the sight of bloody sheets or be panicked you'll lose oodles of amniotic fluid on your brand new couch. Yes, giving birth in your home will likely involve some cleanup—but the good news is you won't be involved in any of it.
"When we arrive at someone's home, we 'set up.' We make their beds using plastic and have all the medical and comfort items out, as well as sort all the supplies," Farrell says. "This way, when mom gives birth, we are ready! I often say, when I leave a house, 'looks like nothing happened here!' because we also clean up and do laundry and make the house presentable again before we leave."
Postpartum Care: Home Birth vs. Hospital Birth
The model of care you receive when you give birth at home is pretty different from what happens in the larger medical system. Instead of the 48-hour hospital stay and the perfunctory six-week visit to give you the all-clear to have sex again, your care with a home birth midwife will be more frequent and detailed. Every midwife has a different way of practicing postpartum, but you'll most likely receive multiple home visits to check up on you and your baby, including several in the first few days and weeks.
Farrell says, of her own practice: "Postpartum visits can easily be one-and-a-half hours. I generally come back three to four times in that first critical week postpartum to help with healing, nursing, and the transition to motherhood. We make sure the postpartum period is about the whole person, meaning that while we're doing medical visits, we're also checking in on how this new family is doing, doing referrals if needed, and generally just assessing that everyone is healthy and safe."
Having this kind of involved, personalized postpartum care can make a huge difference in transitioning families to new parenthood.
Home Birth Cost: Will Insurance Cover It?
Despite the fact that a home birth is usually much cheaper overall than a hospital or birthing center, many families end up paying out-of-pocket for the costs of their midwife. In general, the fee ranges from $1,500 to $3,000, which usually includes prenatal care and six weeks of postpartum care. Rules and regulations related to home birth and midwifery coverage are highly complicated and vary based on location, as well as how and where you get your insurance coverage.