Knowledge: Home Birth
A home birth is when a birthing person gives birth to their baby in the place where they live. Home birth can be planned (87% of U.S. home births) or unplanned (13%) and they are most commonly attended by midwives. 62% of U.S. home births are attended by a midwife who usually provides full prenatal, perinatal and postpartum care (typically up to 6 weeks after a baby is born) for the mother and baby.
The number of home births in America increased 77% from 2004 to 2017 and 1.61% of births in the U.S. occurred outside of the hospital. Research shows that home birth is a safe option for expectant families with low-risk pregnancies and can provide certain benefits such as a lower chance of complication and interventions.
Why Families Choose Home Birth
Families choose to give birth at home for a variety of reasons including a desire for a natural birth, to avoid unnecessary interventions and to have more control over decisions related to their birth.
Other reasons families choose home birth include:
- Belief that home birth is safer than the hospital
- Previous negative or traumatic hospital birth experience
- Dislike of hospitals, doctors, or medically managed birth
- Desire for privacy and to avoid strangers
- Trust in birth as a normal, healthy process
- Lack of separation from baby, easier breastfeeding initiation
- Preference for midwives as caregivers
- Comfortable atmosphere
- Family involvement during the birth (children can be present)
- History of fast (precipitous) labor where it is difficult to get to the hospital in time mind during labor and transfer to the hospital for an epidural.
Midwifery Model of Care
Most home births are attended by midwives who practice based on the midwifery model of care which views birth as a natural process and life event. The midwifery model of care focuses on providing families with safe compassionate care that emphasizes physical, psychological, and social well-being for mothers and their babies.
Many midwives provide personalized care, counseling and education so that families are informed and have control over decisions during pregnancy and birth. Research shows that mothers who birth with midwives experience less complications and medical interventions such as cesarean sections during birth.
The World Health Organization states that “83% of all maternal deaths, stillbirths and newborn deaths could be averted with the full package of midwifery care.”
Midwives can perform a variety of interventions and provide medical treatment depending on their training and licensing. In general, home birth midwives can do the following:
- Intermittently monitor baby’s heart rate with a handheld Doppler and/or fetoscope
- Monitor the woman’s progress of labor
- Perform cervical exams as requested by the mother
- Provide physical and emotional support during labor
- Perform a newborn exam
- Suture any tears after birth
- Recognize complications and transfer a patient to the hospital (most of the time complications are recognized and women are transferred before the situation becomes an emergency)
- Administer oxygen and emergency medications
- Neonatal resuscitation
- Start IV’s and administer IV fluids (some midwives)
In addition to receiving prenatal care from a midwife, women who choose home birth in the U.S. often receive collaborative care from a physician. This may range from a single visit for an acute need, to a back-up arrangement for hospital transfer, to full collaborative care—in which the mother receives duplicative care from a physician and a midwife.
Harvard researchers explain that gathering data around the location of birth can be challenging without randomized studies, but in a systematic review and meta analysis using peer-reviewed protocol for research, McMaster University found “no clinically important or statistically different risk between home and hospital groups.”
Safety for Mothers
Many American families still aren’t aware of their birthing options, such as home birth or birthing centers, but the data shows that women who have planned home births are actually safer from certain complications that can occur during birth. In fact, researchers discovered that when compared to those with planned hospital births, low-risk women had lower rates of:
- Severe acute maternal morbidity
- Postpartum haemorrhage
- Manual removal of placenta
The cohort study in the Netherlands aimed to learn whether low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth. It’s currently the largest study to date into the association between planned place of birth and severe adverse maternal outcomes.
Factors such as transportation, and the midwives training play significant roles in the outcomes of planned home births but when looking at the safety for mothers, the study showed that “There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.”