Are Home Births Safe?
Are you considering a home birth? If so, you should be aware of the safety issues and have a plan in case you need immediate transport to a hospital. For most healthy pregnant women, the risks to you and your baby are minimal, but this is still a controversial issue, with different organizations stating different recommendations. Ultimately, you need to make a decision that is well informed and fits your values and needs.
Although the number of home births is on the rise, this option is not for everyone. The Centers for Disease Control (CDC) reported that from 2004 to 2009, home births rose by 29 percent in the United States, increasing from 0.56 percent to 0.72 percent of all births, or 29,650 home births. But are home births safe?
If you are considering a home birth, understanding the safety information and potential risks is an important part of making a decision. Home births can be a wonderful experience; however, they may not be in the best interest of some women and their babies. Let's take a closer look at whether a home birth would be safe for your particular situation.
In February 2011, the American College of Obstetricians and Gynecologists (ACOG) released a committee report called "Planned Home Birth," which was reaffirmed in 2013. This report included data collected on the risks, benefits, advantages, and limitations regarding planned home births and planned hospital births.
The ACOG stated that there are a number of problems that reduce the quality of available research, such as:
- Small studies
- No comparison to a "control" group
- A limited ability to accurately distinguish between planned and unplanned home births
- Variations in skills, training, and certification of the birth attendant.
Despite these limitations, however, the ACOG reported that looking collectively at the recent studies done on home births and hospital births does clarify a number of important issues regarding maternal and newborn outcomes.
One of the studies cited by the ACOG compared maternal and newborn outcomes of planned home births with planned hospital births. The published medical evidence showed that planned home births carry a two- to three-fold increase in the risk of newborn death compared to hospital births. Specifically, the study showed that neonatal (newborn) death was twice as likely overall with home birth and three times as likely for nonanomalous births (those without birth defects).
The ACOG did acknowledge that the absolute risk of planned home births is low. This means that even though the risks are higher for home births, they're still quite low. The medical data showed that when compared to planned hospital births, planned home births among women who had a low risk for problems had fewer medical interventions, including:
- Forceps or vacuum deliveries
- C-section deliveries
- Third- or fourth-degree lacerations
- Maternal infections
- Maternal interventions, such as epidural analgesia and electronic fetal heart rate monitoring.
Although home births had fewer interventions, they were also characterized by a higher proportion of deaths caused by respiratory distress and failed resuscitation. It could be argued that the lack of intervention in cases when it truly is needed could be increasing the risks to the baby.
The ACOG's findings showed that between planned home births and planned hospital births, the following findings showed similar results:
- Postpartum hemorrhage
- Vaginal and perianal tearing
- Umbilical cord prolapse.
The data also showed the risk for hospital transfers in planned home births was 25 percent to 37 percent for women who were having their first child, and 4 percent to 9 percent for women who had previously delivered children. The main reasons for these were due to:
- Lack of progress in labor
- Fetal distress
- Pain relief
- High blood pressure (hypertension)
- Abnormal fetal position.
It was the committee's recommendation that women who choose a home birth should plan for a timely transfer and an existing arrangement with a hospital for potential transfers that may be necessary if complications occur (see Creating a Backup Plan for Home Births).
The ACOG pointed out that it was important to understand that studies showing home births as "safe" involved mainly healthy pregnant women. They stated that certain women who have a high risk for complications may not benefit from a home birth. Specifically, the ACOG said that women who had the following conditions may have a higher risk for complications during a home birth:
- High blood pressure (hypertension)
- A baby in breech presentation
- Post-term ("overdue" at greater than 42 weeks gestation)
- Twins (or more)
- Prior C-section.
The ACOG was quite adamant to point out that if a woman had a prior C-section, it was an "absolute contraindication" to plan a home birth due to the risks, which may include uterine rupture. The ACOG recommends that women who have had a prior C-section and who want to try for a vaginal birth should do so only in a hospital where immediate medical care is available.
The statistics on maternal deaths were not calculated, as there were too few to analyze.
The neonatal outcomes of planned home births also showed less frequent prematurity, low birth weight, and assisted newborn ventilation. However, they were more likely to have an extended gestation of 42 weeks. The incidence of infections in the babies was not reported.
In their recommendations, the ACOG also stated that if women decide on a home birth, they should consider using a certified nurse midwife (CNM), certified midwife (CM), or a physician who practices at an integrated and regulated health system. The ACOG specifically stated that it does not support the provision of care by lay midwives or other midwives that are not certified by the American Midwifery Certification Board.
They also advised that women who have home births should be offered the standard components of prenatal care, including:
- Group B streptococcus screening and treatment
- Genetic screening
- HIV screening.
Based on the available research the ACOG collected, their conclusion was that hospitals and birthing centers are the safest places for labor and delivery.