Women's Health
Dear Doctor:
A good friend of mine delivered her baby at home. She does not like hospitals and thought giving birth at home would be more natural. She spent a lot of time researching her options and found a midwife to take care of her. In the end she labored for over 24 hours and ended up going to the hospital because the placenta did not deliver on its own and she even needed a blood transfusion. Despite this, my friend still insists a home delivery is safe and the best way to have a baby. How common is it to deliver a baby and home and is it really safe?
Answer:
Dear Reader:
This is a really interesting question. A century ago home delivery was relatively common. In fact my own grandmother was born at home. Today just 39,000 babies in the US are born at home each year. This is less than 1% of all deliveries. A quarter of home deliveries are unplanned often the result of a fast, painless labor process or due to inadequate medical care. The remaining home deliveries are planned typically with the assistance of either a trained midwife or a lay midwife.
Unfortunately the statistics on planned home deliveries show that babies born at home have twice the risk of death and a higher risk of seizures or other neurological problems. Women who received little or no prenatal care and deliver at home are at an even higher risk of the baby dying.
If a woman is considering a planned home delivery it is critical that she determine if she is a good candidate. First, she must have access to a certified nurse midwife, a midwife with a license meeting the standards of the International Confederation of Midwives’ Global Standards for Midwifery Education, or a licensed OB physician. Second, she must have access to safe reliable transportation to a hospital and be within a reasonable distance to a hospital. Third, she should not have a pregnancy condition where a home delivery is considered unsafe. Women with twins, a breech baby, or a history of a prior Cesarean section should not deliver at home. Lastly, she should not have 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.
Approximately 25% of first time Moms attempting a home delivery will ultimately need to be transferred to a hospital. This goes down dramatically to 4-9% for women who have had a prior vaginal delivery. It is critical for the safety of Mom and the baby to have a clear plan of transportation to a hospital with obstetrical services when considering a home birth. Transfers to a hospital typically occur because the labor has stalled, the fetus is in distress, need pain relief, management of bleeding, high blood pressure management or breech presentation. Studies show that infant mortality increases as the distance to the hospital increases due to the delay in treatment.
A recent study in Canada did show low rates of newborn mortality in women meeting the criteria for a home birth and whom had a good relationship with a nearby hospital to provide any necessary services. The women were cared for by highly trained skilled midwives with appropriate licensure and certification which likely had a significant impact on the results. Unfortunately not all women who choose a home birth are appropriate candidates for this.
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 going to consider a home birth she first needs to make sure that she is a good candidate, find a certified midwife or OB physician to care for her, and make clear plans on transportation to a nearby hospital. While your friend’s situation with the retained placenta is relatively uncommon it is a great example how unexpected things can happen while giving birth. Childbirth is a critical time in the health of both Mom and baby. A retained placenta (after birth) can result in life threatening bleeding especially if appropriate medical and surgical treatment is not immediately available.
Choosing to have a home birth is not a decision that should be made lightly or based off the latest information on social media. 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.
Tara Gellasch, MD, is the Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider.
