Home Birth: What You Need to Know

Planned home birth can be a safe and rewarding experience for many people. But if you’re considering this option, it’s important that you consider the benefits and drawbacks, understand the risks, and plan accordingly.

Read on to learn more about the pros and cons of having a planned home birth. You’ll need to work closely with a healthcare professional so you can make the best and most informed decision for you and your family.

Planned home birth means you’ll give birth at home instead of at a hospital or birthing center. You’ll still need the assistance of someone experienced and qualified during labor and delivery.

This may include:

  • a certified nurse-midwife (CNM)
  • a certified professional midwife (CPM) or other direct-entry midwife
  • a midwife whose education and licensure meet international standards
  • a naturopathic or medical doctor who practices obstetrics

The majority of home births are attended by midwives or other birthing professionals.

If you’re considering a home birth, discuss it with a healthcare professional. They should be able to explain what you can expect during labor and birth. They should also talk with you about potential complications and how they would be managed in a home setting.

The healthcare professional should be honest with you about possible risks and whether you’re a good candidate to have a safe home birth. They should also clearly explain the situations when they would recommend transferring to a hospital.

Some research has found that planned home births are associated with a higher risk of infant death or severe injury than births planned at hospitals. For this reason, neither the American College of Obstetricians and Gynecologists (ACOG) nor the American Academy of Pediatrics (AAP) currently recommends home birth.

However, other large studies on planned home birth have found that the rates of neonatal death are extremely low.

2014 studyTrusted Source including nearly 17,000 women who had a planned home birth with the assistance of a midwife found that there was no significant increase in neonatal death compared with planned hospital births.

However, some of these outcomes also have to do with whether the pregnant person was perceived as having a low risk or high risk pregnancy. Among low risk people going through planned home births, there was an extremely high rate of healthy childbirth. For people who are considered high risk, it was less conclusive.

There is still a lot of debate around the safety of planned home births. However, there are numerous factors to consider before you make the decision.

For low risk pregnancies, the risk of neonatal mortality in home births is not significantly higher than in a hospital, as long as a trained medical professional is present to assist.

If you’re a good candidate for a home birth, the best thing to do is start researching and planning.

It is not safe for all people to give birth at home. For example, certain medical conditions, such as preeclampsia or type 1 diabetes, require more advanced care than can be offered at home.

Also, for people who have had a prior cesarean delivery, commonly referred to as a C-section, or who are pregnant with multiples like twins or triplets, home birth can be riskier than giving birth in a hospital. Check with your healthcare professional to see if home birth is an option for you.

Be aware that even with a planned home birth, your midwife or doctor may recommend that you move to a hospital after labor begins. Home birth is safest if done somewhere that is close to a hospital.

This recommendation might be made for the following reasons:

  • You have high blood pressure.
  • You desire pain medications, such as an epidural.
  • Your baby is not positioned correctly.
  • You have vaginal bleeding that isn’t related to bloody show.
  • Your baby is showing signs of distress before delivery (abnormal heart rate) or after birth (signs of a medical condition or difficulty breathing).
  • Labor isn’t progressing.
  • Meconium is found in your amniotic fluid.
  • You experience complications like placental abruption (when the placenta detaches from the wall of the uterus before delivery) or umbilical cord prolapse (when the umbilical cord drops into your vagina before your baby).
  • The placenta isn’t delivered soon enough or isn’t delivered completely.

Pros

  • You have more control over the experience.
  • You’ll give birth in a familiar setting.
  • You’ll have a very high chance of a vaginal birth.
  • You can avoid possibly unnecessary medical interventions.

For many people, the pros of a planned home birth might include:

  • a familiar, comfortable setting
  • more control
  • no pressure to use medications or interventions
  • high chance of having a vaginal birth
  • more support and individualized care than in a hospital
  • opportunity for unlimited skin-to-skin time with baby after birth
  • high rates of exclusive breastfeeding or chestfeeding
  • reduced cost
  • religious or cultural considerations
  • convenience when previous births have happened very quickly

With a home birth, you also have the freedom to choose your own labor positions and other elements of the birthing process. These include whether you:

  • eat or drink
  • take warm showers or baths
  • use candles or aromatherapy

Some of the routine interventions done in many hospitals have been found to lead to worse health outcomes for birthing parents and babies, but they are still practiced nonetheless. Many families choose home birth to avoid unnecessary medical interventions.

Cons

  • It is not a safe option for everyone, depending on your individual risk factors.
  • Insurance may not cover any associated costs.
  • You could still be transferred to the hospital in the event of an emergency.
  • Birth can be messy, so it’s best to be prepared with plastic sheets and clean towels.

With a home birth, your insurance policy may not cover any associated costs. Check with your midwife or doctor to find out more information.

If a home birth is something you’d like to pursue, be sure to choose a trained healthcare professional. Find a certified nurse-midwife, midwife, or a doctor formally associated with an accredited healthcare system.

Birth can be messy, and you’ll need to be prepared with clean towels and plastic sheets. The good news is that the majority of home birth professionals will clean up for you after the baby is born, so you and your family won’t need to worry about it.

In the event of an emergency, you’ll need to get to a hospital. Time could be of the essence. Home births have been found to be safest when they take place near a hospital. It’s important that you’re prepared and have planned for the possibility of a hospital transfer.

Home birth is not a safe option for everyone. Be sure to find a healthcare professional who will assess any risk factors for your particular pregnancy and personal medical history.

It’s also important to find a healthcare professional who can clearly outline when home birth is a safe option for you and when they would recommend a hospital transfer. For many people, it’s safer to give birth in a hospital.

Create a birth plan with your healthcare professional’s approval. Choose a pediatrician and arrange to have your baby seen within the first days following birth.

Just as in the hospital, your temperature, pulse, and blood pressure will be monitored only periodically during a home birth. At home, the baby’s heart rate will also be monitored periodically.

This can be different than a hospital, where it is more common to receive continuous fetal monitoring.

For people who are low risk, it’s been shown that continuous fetal monitoring does not improve outcomes. In fact, it has sometimes been found to lead to worse health outlook, according to the advocacy group Evidence Based Birth.

For someone who’s planning a hospital birth and has a low risk pregnancy, it’s usually recommended to only intermittently check baby’s heart rate (as opposed to continuously). So, when it comes to fetal monitoring in a home birth versus a hospital birth, it can be a similar experience.

There are some more high risk situations where continuous fetal monitoring in a hospital is warranted, but for someone who’s low risk, the risks frequently outweigh the benefits.

With a home birth, your insurance policy may not cover any associated costs. Check with your insurance provider for more information.

You’ll still need to work with a midwife or trained medical professional, and the cost can vary widely, depending on where you live.

Giving birth at home will require a little preparation. A private, peaceful space is important, and if you have older children, you’ll have to decide if you want them home or not.

A birth kit is also useful. You can discuss this with your midwife or doctor to make sure you’ll have everything you need. Most home birth providers will bring a large kit of medical supplies with them for your labor and birth. The supplies they ask you to get on your own will vary depending on your provider.

Basic supplies include:

  • absorbent pads with a waterproof bottom (aka “chux” pads)
  • a peri bottle
  • high absorbency menstrual pads for postpartum use
  • a bulb syringe
  • an antiseptic or antimicrobial soap
  • a cord clamp
  • nonsterile and sterile gloves
  • lubricant
  • a variety of gauze pads
  • alcohol prep pads

Additional items may include:

  • a basin for the placenta
  • a waterproof mattress cover
  • washcloths and towels
  • fresh sheets
  • clean receiving blankets
  • trash bags

One of the advantages of a home birth is the freedom to labor as you please, so you should also consider labor aids such as a birthing pool, a birth ball, and music. Many home birth midwives have birth tubs available to loan or rent to their clients.

A few facts about home births, according to 2019 researchTrusted Source, include:

  • In 2017, 62,228 of births took place outside of a hospital.
  • There were 38,343 home births — a 77 percent increase from 2004 to 2017.
  • There were 19,878 birth center births — more than doubled from 2004 to 2017.
  • Montana and Vermont were the states with the highest percentage of home births.

Also in 2017, 98.4 percent of birthsTrusted Source in the United States were in hospitals

If you’re considering giving birth at home, start by learning more about the ins and outs of this experience.

You can read home birth stories online and look for local organizations that can provide more information. You should also speak with your midwife or doctor about the unique circumstances of your pregnancy.

Once you’ve got the all-clear to proceed, plan and prepare to make sure you have everything you’ll need to give birth to your baby safely at home.

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