Perhaps you’re inching closer to your due date. Perhaps you’re several months before, somewhere in your second trimester. Whichever it is, where you want to give birth is something you will begin thinking about.
If you’re like my mom, you wouldn’t even think twice about the answer to that question. Unless you didn’t make it there on time, you’re giving birth in the hospital!
However, while it is still very uncommon, it is becoming increasingly popular for pregnant women to opt for an at-home birth, or simply a home birth.
Without a doubt, planned home births can be beautiful and rewarding experiences. With that said, there are many factors to consider, both risks and benefits, before moving forward with this very important decision.
What is a home birth?
Simply put, a home birth is giving birth at home, as opposed to at a hospital or birth center. Of course, in most cases there is at least one certified nurse midwife present to facilitate the delivery.
Most recent studies show that 80% of planned home births are attended by certified nurse midwives and direct entry midwives. Older, married women with multiple previous children are more likely to opt for birth at home. As of 2017, 0.85% of births in the United States were planned home births.
With your birth taking place in the comfort of your own home, you get to decide for yourself where you would like it to happen. However, the decision to host the delivery at your place is one that should not be made without the consultation of your health care professionals.
Why should I have a home birth?
Before talking about the risks associated with opting for an out-of-hospital birth, let’s understand why more moms are talking about births at home. Afterward, we’ll round out the home birth pros and cons with why many obstetricians and gynecologists will advise against it:
Here are the pros of home births:
1. It’s at home.
You’re at home, which also happens to be the location of your good friends: Bed, Fridge, Couch, and Closet. You own the place, and you’re going to feel way more comfortable and in control than you would in the delivery room. Plus, you don’t need to rush over anywhere in a panic.
2. It’s the optimal venue for a natural birth.
Especially today, many pregnant women are interested in having an all-natural birth with minimal medical intervention. That is exactly what you can expect with midwife-assisted home birth.
You’ll have many fewer interventions, including pain medication and labor induction; as many as 30% fewer C-sections, and only what needs to be done is done.
3. It is just as safe.
As for the labor and delivery themselves, recent studies have concluded that for low-risk pregnancies, home births are just as safe as hospital births. Knowing they are just as safe can be reassuring for pregnant women who are concerned that they are sacrificing safety by being out of the hospital. However, place an asterisk next to this item - we’ll come back to it in the cons.
4. It is more private and intimate.
With the opportunity to meet and develop a relationship with a certified nurse midwife during their pregnancy and prior to their birth, many women choose to deliver at home to receive that special attention and care.
Women who give birth at home often describe very positive experiences with midwives whom they know and trust. In efforts to maintain as natural a birth as possible, midwives will massage your back and give you that extra love in a private and intimate environment you might not get in a hospital setting.
5. It is far less expensive.
Though your pregnancy and delivery are not a time to be stingy with cash, if not covered by your health insurance, the overwhelming price of a hospital birth can often put a damper on what should be a beautiful experience.
For all these advantages, there are certainly drawbacks and risks involved. Here are some of the cons of home births:
1. It’s not in the hospital.
Yes, you may have the luxury of delivering from the comfort of your own home when you opt for a home birth, but that also means you don’t have nearly the resources that the hospital is equipped to provide you with at a moment’s notice.
While midwives are prepared for hemorrhage, and they come equipped with pitocin, oxygen, and an intravenous drip, you can never be too prepared. Unfortunately, complications do happen, and if they do, you’ll want the immediate attention of a full medical staff in order to avoid any tragic consequences.
2. It’s not without risk.
With fewer maternal interventions, there is also greater risk of perinatal death (around 0.15% of births). Rates of neonatal seizure and neurological dysfunction also increase threefold. However, to keep things in perspective, they are still only 0.05% of cases, meaning 99.95% of the time your baby will be okay.
There’s a reason that your delivery team is intervening, and it is to prevent these unfortunate results. Of course, if any complications do present themselves, you’ll be transferred to the hospital at once. In US-based studies, hospital transfers occurred 10% of the time. For first-time moms, they are far more common, with a prevalence between 22-37% of home births.
3. It’s painful.
Midwives are known for using alternative remedies for pain relief to facilitate a more holistic and natural birth. But the strong stuff (read: epidural analgesia) can only be administered by an anesthesiologist, who is only present in hospital births.
That means your most effective option for pain relief is unavailable. While in the past theories suggested that epidural administration could lower the risk of postpartum depression, this has been debunked by more recent studies that have found no correlation between the two. Nonetheless, with your best bet for pain relief during labor off the table, you may find yourself sacrificing physical pain for psychological comfort.
Should I have a home birth?
Where you give birth is a really big decision.
Watch home birth videos, speak to couples who have opted for home birth before. See for yourself if you think it would be the best choice for you.
That being said, there are certain criteria for home birth candidacy that would be prohibitive of that option in the first place. If you meet any of these criteria, you may be advised against home births altogether:
- You have an underlying condition (heart disease, preeclampsia, anemia)
- You are pregnant with multiples (twins, triplets)
- You are pre- or post-term
- Your baby is not in the right position for birthing (fetal malposition)
- You have low or high amniotic fluid levels
- You have previously undergone a C-section
- You have had past obstetric complications
- You have gestational diabetes
- You live far from hospitals
According to the American College of Obstetricians, any of these conditions will increase the likelihood of necessary medical intervention, and as such they would prohibit the option of an at-home birth.
A good candidate for home birth is at low risk: no medical conditions, no history of obstetric complications, and safely in term with a single pregnancy.
Even without any of these conditions, however, once in delivery you may be transferred to the hospital for a number of reasons. These may include:
- High blood pressure
- Labor is not progressing
- Your baby is in distress
- Excessive bleeding
- Pain relief
Make sure to discuss your options with your OB-GYN, and certified nurse midwife. Talk through your rationale and listen to their professional advice as to your candidacy for a home birth.
Ultimately your pregnancy is unique, and what might have worked for your friend or your sister may not be the best for you. Whatever the case may be, you can be sure that everyone has the same, unified goal of providing the safest environment for you and your baby.