Health & Pregnancy

Home Births on the Rise

Home Birth Not for Every Pregnancy

Saraswathi Vedam is the chair of the Home Birth Section of the American College of Nurse-Midwives’ Division of Standards and Practice. She is also the director of the Division of Midwifery at the University of British Columbia.

She is on the front lines of this home-birth movement. “One would hope the rise is in planned home birth among healthy women with good risk profiles,“ Vedam says.

Home birth is not for every woman or every pregnancy. Women who wish to have a home birth should be full term, not have any blood pressure issues during pregnancy, and should be well nourished. The baby should be growing well and ideally have its head facing downward.

“There should be nothing about the pregnancy that would suggest she will need interventions in the hospital,” Vedam says.

The large variations in the percentage of home births by state may be influenced by differences in state laws pertaining to midwifery practice or out-of-hospital birth, according to the study.

Women interested in home birth should do their research, and make sure that the provider has access to a hospital if they change their mind.

Not Everyone on Board

Based on his own experiences, Gene Burkett, MD, is not sold on home births. He is a professor of obstetrics and gynecology at University of Miami Miller School of Medicine in Florida. “The downsides are that when something goes wrong, such as an abnormal fetal heart rate, you have to respond in a manner that gets the patient delivered immediately,” he says.

Things can go wrong, they can go wrong quickly, and this is not always predictable.

“Even with careful selection, one can get into difficult situations which demand immediate delivery, and you must have some way to deal with that rapidly,” he says.

A compromise between the hospital and home may be a birthing center. “These can be unobtrusive, but not too far away from a hospital,” Burkett tells WebMD.

ACOG states that planned home births do carry a two- to three-fold increase in the risk of newborn death, compared with planned hospital births. Former ACOG President Richard N. Waldman, MD, says that "it's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as [high blood pressure], breech presentation, or prior cesarean deliveries."

ACOG believes that hospitals and birthing centers are the safest place for labor and delivery. That said, the group encourages women who decide to deliver at home to take full advantage of prenatal care.