When most of us think about the birth of our baby, we ask questions like Who do I want in the room? Which doctor/midwife do I want at the delivery? and Will I have a bowel movement while pushing (don’t stress if you do; it’s super common)? Until recently, very rarely did the question At home or in the hospital? cross our minds. However, over the past few years, home birth has gained some serious followers.
More and more women are opting to deliver their baby in their bedroom rather than in birth centers or hospitals. In fact, rates of home birth were up from .79% in 2004 to 1.3% in 2012. Fear of C-Sections and the medicalization of birth (monitors, medications, and modest autonomy) have collectively driven women out of hospitals and into their homes. While there are certainly benefits to home births (minus the cleanup factor—labor can be quite messy), there are some major downsides as well. Here’s what to consider if you are considering a home birth.
First, deciding to deliver at home is a BIG, BIG, BIG decision that should not be made alone. While we get that women have been delivering babies for centuries, things can still go wrong, very wrong and very fast. That’s why it’s super important that you speak with a medical practitioner (OB/GYN or midwife) to make sure that you are a good candidate for an at-home delivery. According to the ACOG, the following women are on the no-fly list when it comes to at-home births: a previous C-Section, babies who are not head down (medical term: fetal malpresentation), and multiple gestations (more than one baby in their uterus at one time). It is just way too risky.
Second, if you are good to go for it at home, make sure you are not alone. Seek out a midwife who is licensed and experienced in doing home births. You want to make sure that this is not their first rodeo. Knowing when to throw the towel in and trek over to the nearest hospital is essential.
Third, have a good idea of your surroundings. And while we aren’t referring to the nearest grocery store, we are referring to your local hospital. Being close to a medical facility can be the difference between a horrible and heroic outcome.
Why do we care so much? Well, we care about you and your baby’s safety—big time. And although most home births go off without a hitch, when compared to hospital deliveries, home births carry a significantly higher risk of bad outcomes. A large study that was recently published in the JAMA (the Bible of all good medical research) showed that death, neonatal seizures, and neurological impairment were nearly 2.5 times more likely to occur when babies were delivered at home as opposed to in the hospital. Additionally, mothers who delivered at home were more likely to need a blood transfusion. But to be fair, the data wasn’t all down on home births. Women who delivered in a hospital were way more likely to have their labor augmented (a.k.a. enhanced with drugs like Pitocin) and have a C-Section.
As doctors, we have opinions…lots of them. Most of these are rooted in research, data, and years of medical education and training. But despite our degrees, we are not dictators. We are, in many ways, nothing more than trusted advisors. Therefore, while we can give our advice and render an opinion, we can’t tell you what to do. That’s up to you. You take the information we give you and with it make an educated and informed decision.
But we’re not going to lie; on this issue, we side with the ACOG and truly believe that the safest place to deliver a baby is in the hospital or in an accredited birth center. In our opinion, the potential downsides of the at-home birth far outweigh the potential downsides of the hospital birth. And while bad things can happen anywhere, we would rather you go where they happen less.
We also get that the labor and delivery of a child is one of the most intimate experiences in one’s life. You want what you want. We know; we were patients, too. Our advice is to find a practitioner (OB or midwife) whose vision for labor and delivery is close to yours. While on D-Day what you expected while expecting and what happened may be very different, at least you are staring from a place of togetherness.
Labor is as unpredictable as the weather in the tropics. Things can change faster than you can imagine. Get ready to roll with whatever rolls in…it will allow you to weather the storm safely. Make sure you have a life jacket and safety net (a.k.a. good medical practitioner on your side) should the seas get rough.