Home birth

Up until the late nineteenth century, home birth was common in the United States, and the majority of babies were born at home. In some countries, such as the Netherlands, home birth is still a popular option. In the United States, however, childbirth moved from the home to the hospital in the early 1900s. By 1969, less than 1 percent of American women chose to have their babies at home. A number of studies have shown that home birth has become a more popular choice for U.S. women in recent decades. The World Health Organization (WHO), the American College of Nurse-Midwives, and the American Public Health Association have said that they support a woman's decision to have a baby at home, stating that the risk factors involved are approximately the same as in the hospital, as long as the mother is considered low-risk. The American College of Obstetricians and Gynecologists also supports the right to choose a location for childbirth but stands behind the belief that hospitals and birth centers are the safest options.

Brief History

In the early 1900s, as cities grew and hospitals and medical centers were established, childbirth evolved from a private, at-home event that was often supervised by a nurse-midwife to a hospital procedure overseen by a physician. By 1940, less than half of American women were having their babies at home. By 1969, that number fell to less than 1 percent.

Although the number of women who choose to have their babies at home is still under 1 percent, the number is growing throughout the country. According to the Centers for Disease Control and Prevention (CDC), between 2004 and 2009, the number of reported home births rose 29 percent. Approximately 35,000 babies are born at home each year in the United States. One quarter of them are accidental or unplanned births, while the other three-quarters are planned home births. The majority of women choosing to birth at home are white, and the practice is more common among women over the age of thirty-five and among women who have other children already. The highest incidence of home birth was reported in Montana, Oregon, and Vermont, and the lowest was reported in the District of Columbia and Louisiana in 2009.

Reports on the safety of home births vary significantly, based on who is conducting the study and the group of women included in the study. For example, the statistics on planned versus unplanned home births differ greatly. The majority of studies seem to demonstrate that having a baby at home is generally as safe as having one in the hospital as long as certain precautions are taken.

Overview

The reasons a mother chooses a home birth vary from individual to individual. Some of the most common reasons women choose a home birth include the following:

a desire for minimal medical intervention, which could reduce the chances of requiring an episiotomy or a caesarean section (C-section)

a desire to avoid the hospital environment

a desire to be close to family and friends in a familiar and comfortable location during an intense and intimate experience

a desire to move around, shower, eat, and drink as needed during labor

the opportunity for immediate bonding and breastfeeding with the baby after birth

the opportunity to choose alternative care and utilize treatments such as herbs and oils

the opportunity to have a water birth

the opportunity for other children to participate in the labor process

the ability to be in control of the overall birth experience

Some women also choose home birth because the cost is far less than it would be in the hospital (for both insured and uninsured patients) or because of their cultural or religious beliefs.

Although most medical organizations support a woman's right to choose her birthing location, they do establish guidelines about which women can or cannot safely birth at home. Women who birth at home should be low-risk, meaning they should not have health conditions such as diabetes, high blood pressure, or another chronic illness. Additional guidelines recommend that women who are going into labor preterm (before thirty-seven weeks) or postterm (after forty-one weeks) should not have a home birth. Women who have had previous C-sections, appear to have a fetal malpresentation (breech birth), or have a pregnancy complication, such as preeclampsia, should not give birth at home either. Doctors also discourage mothers of multiples from birthing at home. Finally, many experts suggest women get the full support of their partners and/or families before attempting a home birth.

In addition to being low-risk, mothers who opt for home birth are expected to obtain quality prenatal care from an OB/GYN/physician and/or nurse-midwife. Laboring mothers are also encouraged to have a trained professional attend the birth, usually a certified nurse-midwife. Most midwives attend home births with all the equipment they may need for a possible emergency, including oxygen tanks, IV supplies, and various medications. The majority of midwives also bring sterile gloves and pads, waterproof covers for the bed, and various herbs and oils. Postpartum care after the birth is also essential. Families are often advised to have a plan B ready if they run into problems or complications and require transportation to the nearest hospital. This is sometimes needed if labor is not progressing properly, the baby shows signs of fetal distress, the mother has excessive vaginal bleeding, the placenta appears before the baby (a condition known as placental abruption), or the umbilical cord gets in front of the baby (known as umbilical cord prolapse).

Bibliography

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