For many years, childbirth advocates, medical providers and parents have argued over whether or not home births are safe. In some places, legislation dictates whether or not parents may have the choice to have a midwife attend a home birth or the qualifications of the midwife. What do we know about home birth safety? Who is in opposition to home birth and how can parents make sure that this option will still be available to them?
Obstetricians Oppose Home Birth
At the heart of the argument against home birth are physicians, specifically obstetricians. ACOG (American College of Obstetricians and Gynecologists) stands firm in its position in favor of hospitals as the preferred birth location. In 2008, ACOG made a public statement that said it would not support programs that advocate for or professionals who provide home birth services. In fact, these obstetricians oppose home birth to such a degree that they believe mothers are not making a safe decision for their babies.
ACOG states that "choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."
Pediatricians' Support Divided on Home Birth
Research presented at the Pediatric Academic Societies in 2009 indicates that home births may be associated with a higher rate of newborn death. Dr, Michael Malloy, of Galveston, TX, reports that in his research of over 12 million births over a 5 year period, the rate of newborn deaths in midwife-attended home births was more than double the rate of newborn deaths in the babies delivered by a nurse midwife in a hospital. While researchers conducting this study did not suggest that home births should be banned, it makes a clear argument against their safety.
Parents should be reminded however that individual pediatricians may differ in their opinions regarding home birth. In our online research, we found several independent pediatricians in various regions who were supportive of home birth in their practices.
Midwives Support Home Birth Option
Most certified nurse-midwives and certified professional midwives do support the option of home birth for families. Midwives of North America (MANA) believes that ACOG and the AMA both have ignored the scientific evidence that home birth is a safe alternative to hospitals. The American College of Nurse-Midwives (ACNM) states that women who meet certain criteria should have the option of home birth since planned home births attended by a qualified attendant have been shown to have the same or better outcomes than most planned hospitals births.
Legislation Against Home Birth
As of July 2010, Australia will require that midwives who offer home birth services must carry indemnity insurance. However the biggest problem is that insurance providers do not provide this type of insurance to midwives. As a result, midwives will be prohibited from attending home births.
Some experts speculate that this shift in the legislation on home births may force parents who choose home birth in Australia to birth alone, known as "free-birthing" or having an unassisted birth.
Consumers' Opinions Mixed on Home Birth
What do parents say about home birth safety? Not many parents are making the choice for home births these days. Only 1% of parents in the United States choose home birth as their chosen place of birth. However in other regions, it is much more common. The Netherlands still leads the world in the greatest percentage of mothers choosing home birth at 30%.
The parent-consumers who choose home over hospital to give birth often do so to avoid unnecessary medical interventions, to reduce their chances of having a cesarean and to have a level of control over the experience of giving birth.
Some parents may also recognize the risk of a HAI (hospital-acquired infection) and choose a home birth to reduce their baby's and their own chances of getting infected. Often parents have a previous negative experience giving birth in a hospital setting and they desire to have a more positive experience.
Many parents associate a hospital with greater safety and the majority of mothers choose to have their babies in a hospital. Ready access to anesthesia, operating rooms and the NICU (Neonatal Intensive Care Unit) is appealing to parents who many have concerns about possible complications during childbirth. However giving birth in a hospital is no guarantee of fewer complications and in many cases, research shows that more interventions are likely to occur in hospital births.
What to Consider About Home Birth
Before you make any decisions about your place of birth, be sure you are prepared and informed about all of the risks and benefits of each. Take the time to interview qualified care providers who provide services at home or at hospitals. Decide what is most important to you.
Be sure that you have a contingency plan for transfer and that you live 10 minutes or less from the nearest hospital if you plan to give birth at home. You may also want to explore other options, such as free-standing birth centers in your area, in addition to a home or hospital.
As a mother you should have the right to give birth in the way that is best and safest for you.
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