The demand for natural child birth and giving birth outside of the hospital setting is increasing in the United States. However it is a topic that remains controversial. There is no shortage of glowing stories from happy mothers of safely home birthed babies, but there are horror stories as well. Planned home births are generally considered safe for healthy women with low risk pregnancies being attended by certified nurse midwifes with a good system in place for transfer to a hospital when necessary. The question is this, what are the pros and cons of home birth? Let’s begin with assessing the risks of giving birth at home. This is difficult to do since there are not many well designed studies that have been conducted from which to cite statistics.
Many statistics include births that occur outside of the hospital setting that are not planned, also home births not attended by certified midwifes that are much riskier and more likely to have a poor outcome. However this data also does not account for when planned home births become hospital births when complications arise, which leads to an underestimation of the risk and overestimation of the benefit of home birth. Home births appear to include a shorter recovery time and fewer lacerations, post-partum hemorrhages, retained placenta and infections, however it is associated with a higher neonatal mortality rate. There is also the issue of who is attending these births. There are differences in the type of midwifes.
A Certified Nurse-Midwife (CNM) is an individual trained and licensed in both nursing and midwifery. Nurse-midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.
A Certified Professional Midwife (CPM) is an individual trained in midwifery who meets practice standards of the North American Registry of Midwives. A Direct-Entry Midwife (DEM) is an independent individual trained in midwifery through a variety of sources that can include: self-study, apprenticeship, a midwifery school, or a college/university program.
These are the most common types of midwifes used by women today. Then there is a Lay Midwife: an individual who is not certified or licensed as a midwife but has been trained informally through self-study or apprenticeship.
The data suggests that planned home births involving healthy and low risk mothers attended by certified nurse midwifes compared with planned hospital births in the same group of women doubled the risk of neonatal deaths. The main attributing factors for the increase in mortality rate were the occurrence of breathing difficulties and failed resuscitation attempts. These factors are associated with poor midwife training and a lack of access to hospital equipment. In the USA only a third of home births are accompanied by certified nurse midwifes. Sufficient data involving non-certified midwifes is not available, and their use in planning a home birth is generally not recommended.
With all these risks in mind there is still no shortage of evidence to support how safe homebirth can be when arranged and carried out cautiously. Home births generally have a lower risk profile than hospital births. In 2011 the percentage of home births that were preterm was 6%, compared with 12% for hospital births. The percentage of home births that were low birth weight was 4%, compared with 8% for hospital births. Less than 1% of home births were multiple deliveries, compared with 3.5% of hospital births. The lower risk profile of home births may suggest that home birth attendants are carefully selecting low-risk women as candidates for home birth.
There are many benefits to giving birth at home. Women often experience less pain when giving birth at home. The sensations of labor are regulated by hormones released by the woman’s body, such as oxytocin and endorphins. During a homebirth, the woman is more relaxed and her body will release these hormones according to her needs and she is therefore usually able to cope well with the sensations of labor. If a woman feels uncomfortable in her environment this causes her body to secrete adrenaline, causing the levels of oxytocin and endorphins to drop. She therefore experiences more pain than she would in the comfort of her own home. Lower levels of intervention are also associated with homebirth because of the balance of these hormones.
The increase in adrenaline a woman would experience in an environment she is uncomfortable in will inhibit the release of oxytocin and labor may slow down. This results in the use of a drug, usually Pitocin or Syntocinon, to speed up the labor. This can cause distress and often leads to a cascade of intervention which may result in an instrumental delivery or cesarean. Through all this medical intervention, the woman’s choices are often not sought, thus leaving her to feel out of control of her birth. Hospitals need to have systems in place in order to run efficiently and this does not leave room for individualized care. Women often feel restricted by hospital policy and routine.
This is in contrast to delivering at home, where the woman is in charge, giving her greater satisfaction than in a hospital setting. Another benefit of homebirth, though not often instrumental in a woman’s decision between a hospital and a homebirth, is cost. Having a baby is the No. 1 reason for hospitalizations in the U.S., and a Cesarean section is the most common operation. In 2006, $86 billion was spent on maternal and newborn hospital charges, but despite this spending, our infant mortality rate ranks 29th among industrialized nations and our maternal mortality rate is a dismal 36th. In 2008, the March of Dimes gave us a “D” for our work on preventing preterm births.
Experts have dubbed this phenomenon of doing more but accomplishing less the “perinatal paradox.” “Practices that have proved to make childbirth safer, easier and less expensive are underused, while costly interventions such as induction and repeat C-sections that may increase risks to mothers and babies are routinely overused,” says Maureen Corry, executive director of Childbirth Connection, a nonprofit group that promotes evidence-based maternity care. It is important to have a well-researched strategy when planning a homebirth. There are things you can do to ensure your homebirth is as safe as possible.
First find a good practitioner, preferably a certified nurse midwife with plenty of experience. Verify her education and credentials as well as references. Also be sure your caregiver carries the necessary medical equipment and supplies in the case of an emergency. Ensure she has a supportive backup doctor and nearby hospital in the event you would need to be transferred. Make sure your backup plan is solid. Make sure the backup hospital is close and you have transportation. Establish a relationship in advance with a pediatrician to see your baby after it’s born.
It is important for women to regain control over the process of giving birth and have the right to choose how and where to give birth. They do not, however, have the right to put their baby at risk by putting greater emphasis on the process of giving birth than the goal of having a healthy baby. It is important to note that hospital delivery is still the preferred method of delivery for high risk pregnancies or in cases where reliable certified nurse midwife care is not available. In the end, lack of control with childbirth choices and support for natural childbirth options in the hospital setting are the driving force behind more women choosing the homebirth option.
Tuteur, MD, A. (2011, December, 30). Homebirth 2011: Statistics and scientific papers. Retrieved from http://.skepticalob.com/2011/12/homebirth-2011-statistics-and.html
MacDorman, Ph.D., M. F., Mathews, M.S., T. J., & Declercq, Ph.D., E. (2012, January, 01). Home births in the united states, 1990–2009. Retrieved from http://.cdc.gov/nchs/data/databriefs/db84.htm
Wax, J., Lamont, M., Pinette, M., & Lucas, L. (2010, July, 02). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.
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Types of birth settings. (Anonymous, 2010, September, 9).
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