More and more, women are opening up about their paths to motherhood and are sharing their birth stories with the world. At-home births are a growing trend, increasing rapidly in popularity among moms to be. They are especially appealing to those who seek natural, alternative and holistic alternatives to hospital births. But are they safe?
BRIDES spoke with Dr. Erin Higgins, clinical instructor in the Department of Obstetrics and Gynecology at NYU Langone Health for more information that anyone considering a home birth should know.
“Home birth has become increasingly popular in recent years due primarily to a desire to avoid medical intervention and have a more personalized birth experience,” explains Higgins. Patients who dislike the hospital atmosphere also might tend to view a home birth as a better option. However, she is generally opposed to the practice due to the risks and potential for delayed treatment in the case of emergencies. “I agree with the position of the American College of Obstetricians and Gynecologists (ACOG) that hospitals and accredited birth centers are the safest settings for delivery,” she says. Yet, she recognizes that it is a patient's right to decide where to deliver after carefully weighing and considering all the available information. Higgins adds, “Anyone who chooses to have a home birth should have access to a nearby hospital and be willing to transfer should need arise.”
Benefits and Risks
Perhaps the most appealing aspects of a home birth is the ability to give birth while having access to all the comforts and amenities you’re used to, yet there is limited data on the safety of home births due to a lack of clinical trials.
However, Higgins explains, “Some studies have shown less intervention in the labor process (including induction or augmentation, fetal heart rate monitoring, episiotomy, epidural, operative delivery, and cesarean delivery) and less maternal morbidity (including fewer lacerations and a lower risk of infection and hemorrhage) compared to hospital births."
Risks of home birth typically relate most to the baby, with higher rates of perinatal death, neonatal seizures, and neurologic dysfunction. Higgins clarifies that perinatal death, “refers to death prior to delivery and up to four weeks after birth, and has been found to be 2.4 times more likely in home births compared to hospital births.”
Because labor is an unpredictable process and emergencies happen even in low-risk patients who give birth in the hospital, it’s considered that hospitals are the safest place to give birth. Higgins adds, “infection and prolonged labor without progress, while not emergencies, represent problems with the labor process and risk to both the patient and baby.” In any of these cases, she says, the patient should be transferred to a hospital.
Are You a Candidate?
If you are considered a high-risk pregnancy, you should not consider a home birth. The “high-risk” category applies to, but is not limited to, anyone with multiple gestation (twins or more) or a prior cesarean section or other uterine surgery. If your baby is considered to be malpositioned (aka any position that is not head down), Higgins also advises to not attempt a home birth. Women with pregnancy-related conditions that could complicate your labor including preterm labor, gestational diabetes or preeclampsia are also then at increased risks with home births.
The Home Birth Necessities
If you’re considering a home birth, it’s important to ensure a trained and licensed midwife or obstetrician is present, according to Higgins. She explains, “The obstetric provider will attend to both the patient and the baby once it is born. The provider should be trained in neonatal resuscitation in addition to their training in obstetrics,” adding they should also have basic medical supplies (oxygen, IV supplies, and medications to stop bleeding if it occurs).
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While Higgins has not personally had any patients opt for a home-birth, she has had patients transferred to the hospital after attempting them. Generally, she explains, “these patients have had some problem during their labor that has caused them to seek out medical care in a hospital, so I have likely seen a higher rate of complications than is typical.”
The decision of where and how to give birth is largely up to the mother, yet as with all important decisions, having access to thorough and accurate information is key. All pregnant women should consult with their OBGYNs and/or midwives about their intentions and plans, and ask any and all questions they might have.