Home birth

Considering home birth? You’re not alone. Some families have always opted for home, but with local hospitals closing, concerns about safe and equitable hospital care, or exposure to infections like COVID-19, it’s an option more families are exploring. Still, only about 1.3% of babies in the U.S. are born at home. Home birth may be a safe choice for some families.

Is home birth a good fit for your family 

The first thing you’ll want to know is if you state allows a provider to help you give birth at home. Laws vary from state to state, and there are a few states where it may be illegal for a provider to attend your birth at home. 

If it is a legal option in your area, you’ll then want to consider your own health and pregnancy risk factors. Home birth is generally not a good fit for those with a baby who’s not head-down, those who are having twins or a multiple pregnancy, or those who have had a C-section before. 

A lot of other health conditions or risk factors could also mean a home birth isn’t a good fit for you, like having a bleeding disorder, high blood pressure, gestational diabetes, or a history of preterm birth.

What do the experts say?

Both the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) believe that every person has the right to make an informed choice about the location for childbirth, but there is still some conflicting information. 

According to ACOG’s analysis and position statement, there are lower rates of interventions and perineal tears when birthing at home, but there are also higher risks of poor outcomes for babies born at home, like higher rates of seizures. 

In contrast, recent studies highlighted by ACNM suggest that planned home birth for those who are low-risk and working with a qualified provider are just as safe for both parents and babies. They suggest that in these circumstances, home birth might even lower some risks, like the risk of getting a hospital-acquired infection. This may be particularly significant for those who are Black, Indigenous, People of Color, or living in a rural setting. 

Though ACNM and ACOG’s opinions differ on the overall safety of home births, both organizations believe that there are certain levels of care that should be in place to ensure the health and safety of parent and baby. This means that the birth attendant should:

  1. Be a certified nurse-midwife (CNM), certified midwife (CM), or physician who can provide the care you expect during pregnancy and birth.
  2. Be able to access consultation with an appropriately licensed colleague when needed for problems that may come up during pregnancy and labor.
  3. Have a plan for a transfer process if you do need to have your baby at the hospital or if you or your baby needs urgent care after birth.

Next steps 

If you’re thinking about choosing a home birth, here’s a list with examples of questions to ask your potential provider to help you make the best and safest choice for you and your family:

  1. Are you a CNM, CM, or physician who is licensed by the state to practice home birth?
  2. How much experience do you have attending home births?
  3. How close to the hospital should I live to be eligible for home birth?
  4. Is my health and pregnancy low-risk enough to be safe for home birth?
  5. What supplies do I need to have at home?
  6. What supplies and medications do you bring with you?
  7. How do you handle potential complications or emergencies, like excessive bleeding after birth or a newborn who’s having difficulty breathing?
  8. How can you help to manage my pain and comfort during labor and birth?
  9. How often do people in your care transfer to the hospital, and why?
  10. How do they get transferred and are ambulances available near me?
  11. Who will take care of me at the hospital if I do get transferred?
  12. What is the cost of home birth care, what’s included, and is it covered by insurance?

Ultimately, you deserve to make the best possible choice for yourself, your baby, and your family. 

Reviewed by the Ovia Health Clinical Team

Sources

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