Women's Health

Giving Birth At Home

How common is it to deliver a baby at home and is it really safe? Tara Gellasch, MD, gives insight into what to expect with a home birth and what to do if things don’t go according to plan

Jun. 7, 2017 5   min read

Giving birth to a baby at home was a relatively common practice 100 years ago. With the advances in medicine over the last several decades, most births in the U.S. now happen at hospitals. Approximately 35,000 babies are born at home each year – accounting for fewer than 1 percent of all deliveries.

Most home deliveries are planned typically with the assistance of either a trained midwife or a lay midwife.

Tara Gellasch, MD, is an OBGYN specialist with Rochester Regional Health and discusses home births, their risks and benefits, and what women should plan for.

Basic guidelines

The American College of Obstetrics and Gynecology is steadfast in supporting hospitals and accredited birth centers as the safest places for birth – both for the baby and mom. If a woman is considering a planned home delivery, it is critical that she determine if she is a good candidate.

Any woman giving birth at home is strongly encouraged to adhere to some basic guidelines.

Access to a certified nurse midwife

A midwife should have a license meeting the standards of the International Confederation of Midwives’ Global Standards for Midwifery Education, or a licensed OB physician. Each midwife should also be licensed in the state where they practice.

Reliable transportation

Each woman must have access to safe reliable transportation to a hospital and be within a reasonable distance to a hospital.

It is critical for the safety of both the mother and baby to have a clear plan of transportation to a hospital.

Pregnancy conditions

A home delivery is considered unsafe if the pregnancy carries greater-than-normal risk. Women with twins, a breech baby, or a history of a prior Cesarean section should not deliver at home.

The risk of being transferred to a hospital during a home birth is approximately 4-9 percent for women who have had a prior vaginal delivery. 

Risk factors for mother

A woman may be considered a high-risk pregnancy for reasons such as elevated blood pressure, preeclampsia, diabetes and morbid obesity.

Women with these conditions are not good candidates for home birth given the higher rates of complications for mom and the baby. 

Advanced planning

Choosing to have a home birth is not a decision that should be made lightly. Women considering this option for their family should do appropriate research to ensure they are a good candidate and have the resources they need to improve the safety. 

Discuss home birth with your insurance provider about what services they cover. Knowing the potential costs associated with a home birth is important.

Having a plan on transportation to a local hospital in case of a health emergency during labor is incredibly important. Approximately 25 percent of first-time moms attempting a home delivery will ultimately need to be transferred to a hospital. This can happen for a number of reasons, including:

  • Stalled labor
  • Distressed fetus
  • Baby in breech position
  • Pain management desired
  • Management of high blood pressure

Studies show that infant mortality increases as the distance to the hospital increases due to the delay in treatment.

“Babies born at home have twice the risk of death and a higher risk of seizures or other neurological problems,” Dr. Gellasch said. “Women who received little or no prenatal care and deliver at home are at an even higher risk of the baby dying.”

For women who meet the health criteria for a home birth and establish a good relationship with a nearby hospital for any necessary services, a recent study in Canada showed low rates of newborn mortality. The women were cared for by highly trained skilled midwives with appropriate licensure and certification, which likely had a significant impact on the results.

Prior to starting or stopping any treatment, women are strongly encouraged to confer with their own health care provider.

Rochester Regional Childbirth Centers 

The health care professionals at the birthing centers at Rochester Regional Health work with you to provide support and guidance throughout your labor and delivery.

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Tara L. Gellasch, MD
Obstetrics And Gynecology
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