Are Home Births Safe?

Although home births account for less than 1% of all births in the United States, they have gained increasing visibility in recent years. Women opt for home births for various reasons such as:

  • They want the comfort of being in their own environment
  • They would like to avoid medical interventions
  • They prefer to not “medicalize” childbirth.

Whatever the reason, it’s important to know the risks and benefits of deciding to give birth at home.

Home Birth Pros & Cons

An October 2013 study in the American Journal of Obstetrics and Gynecology shed some interesting light on home births.

The study found that babies born at home or in freestanding birth centers (not within a hospital) were significantly more likely to have seizures, neurologic dysfunction, or an Apgar score of zero at 5 minutes.

An Apgar score is a general score of a baby’s health at birth determined through various measures such as a baby’s heart rate, breathing and muscle tone. A score of zero means a baby has no signs of life. According to the study, home births are associated with an almost tenfold increased risk of having a low Apgar score.

Put another way, out of 1,000 babies born in a hospital, fewer than one of them would have a score of zero. That number increases to almost two babies out of 1,000 when delivered at home. That may not sound like that big a difference, but it is significant if that outcome personally affects you.

The study is noteworthy for a few reasons:

  • It was done in the United States (this is important because other countries’ health care systems don’t always mirror ours, so applying their home birth data to the U.S. is not always accurate)
  • It included almost 14 million deliveries — that’s a lot of babies!

Safety of Home Births vs Hospital Births

Studies have shown that women who birth at home have:

  • Fewer C-sections
  • Fewer episiotomies
  • Fewer forceps/vacuum deliveries
  • Lower rates of infection
  • Lower rates of vaginal tearing

The American Congress of Obstetricians/Gynecologists’ (ACOG) official position is that hospitals and birth centers within hospitals are the safest place to deliver.

However, ACOG does state that a woman’s right to choose to birth at home should be respected, but that providers are obligated to discuss the risks and benefits of home births. Home deliveries should only be reserved for the lowest-risk women with access to safe and timely emergency transport should it be needed, and mothers should be attended by certified midwives or certified nurse midwives who are highly trained.

There are ways to make hospital births less institutional and more home-like, such as delivering with a hospital midwife, wearing your own clothes, moving freely during labor and intermittent fetal monitoring. If you have these preferences, be sure to discuss them with your provider ahead of time. Doing so can result in a hospital birth that allows you some of the comforts of home, with access to immediate emergency care should it be needed.

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