Sometimes patients tell me, I would really like to labor in the comfort of my own home. I don’t want to be attached to fetal monitors, IV’s, medications or anything. I would like to be in my own tub laboring in peace. I also don’t want any pain medication, so do I really need to come to the hospital? Ultimately, it’s up to you and the complexity of your pregnancy. While it’s not a service we offer, here are a few considerations for those who are considering this option.
The most common arguments for home births that I hear are…Women have been doing it for thousands of years so why do I need to be in a hospital. So it’s generally not about the mom, it’s more frequently about the baby. Of the studies that have been done comparing home births versus hospital birth, there is no increase in maternal mortality, but there is a significant increase in infant mortality. That being said, the number one cause of maternal death in developing countries is postpartum hemorrhage, and access to postpartum pitocin has been the most critical medication for reduced risk of postpartum hemorrhage. As for babies, the risk of neonatal (infant) death is actually elevated at 2 to 3 times higher with home birth than in the hospital. This is rather concerning as it does not take into account that most women that elect home birth are healthy with low risk pregnancies. Hospital births include everyone: high risk pregnancies, women with lots of medical problems who sometimes are very sick even before they become pregnant, and women with no prenatal care. So, despite the fact that most home births involve very low risk pregnancies, the fact that infant death is so much higher is somewhat worrisome. If you do decide to go with a home birth, please make sure that your home birth attendant is certified in infant resuscitation and has plenty of experience. The number of births attended may vary markedly from one midwife to the next, so be sure to take her experience into consideration. It may also be prudent to select one that feels very comfortable taking care of the baby in case a complication arises.
What is the chance that I will be emergently transported to the hospital from home? The chance is actually probably higher than you might think if you are a first-time mom: about 30%. Reasons can include fetal distress or very slowly progressing labor. If you are not a first-time mom, that risk is around 10%. Being transported emergently to the hospital without an established provider can be a pretty harrowing experience, and it’s important to be aware that home birth attendants often don’t have privileges to manage your care once you reach the hospital. That being said, a provider’s transport rate can be a little misleading as well. Often, a home delivery attendant with a higher transport rate tends to have slightly better outcomes as she may be avoiding worse outcomes by allowing more timely intervention for complicated patients. Please know where your closest hospital with good maternal and infant care is located, just in case.
I guess the final question if you elect a home birth is who will clean the floors and the tub ;) Whatever you decide, we want you and your baby to be safe and healthy, so as you hope for the best, be sure to plan for the “just in case” :)
Dr. Pam
The most common arguments for home births that I hear are…Women have been doing it for thousands of years so why do I need to be in a hospital. So it’s generally not about the mom, it’s more frequently about the baby. Of the studies that have been done comparing home births versus hospital birth, there is no increase in maternal mortality, but there is a significant increase in infant mortality. That being said, the number one cause of maternal death in developing countries is postpartum hemorrhage, and access to postpartum pitocin has been the most critical medication for reduced risk of postpartum hemorrhage. As for babies, the risk of neonatal (infant) death is actually elevated at 2 to 3 times higher with home birth than in the hospital. This is rather concerning as it does not take into account that most women that elect home birth are healthy with low risk pregnancies. Hospital births include everyone: high risk pregnancies, women with lots of medical problems who sometimes are very sick even before they become pregnant, and women with no prenatal care. So, despite the fact that most home births involve very low risk pregnancies, the fact that infant death is so much higher is somewhat worrisome. If you do decide to go with a home birth, please make sure that your home birth attendant is certified in infant resuscitation and has plenty of experience. The number of births attended may vary markedly from one midwife to the next, so be sure to take her experience into consideration. It may also be prudent to select one that feels very comfortable taking care of the baby in case a complication arises.
What is the chance that I will be emergently transported to the hospital from home? The chance is actually probably higher than you might think if you are a first-time mom: about 30%. Reasons can include fetal distress or very slowly progressing labor. If you are not a first-time mom, that risk is around 10%. Being transported emergently to the hospital without an established provider can be a pretty harrowing experience, and it’s important to be aware that home birth attendants often don’t have privileges to manage your care once you reach the hospital. That being said, a provider’s transport rate can be a little misleading as well. Often, a home delivery attendant with a higher transport rate tends to have slightly better outcomes as she may be avoiding worse outcomes by allowing more timely intervention for complicated patients. Please know where your closest hospital with good maternal and infant care is located, just in case.
I guess the final question if you elect a home birth is who will clean the floors and the tub ;) Whatever you decide, we want you and your baby to be safe and healthy, so as you hope for the best, be sure to plan for the “just in case” :)
Dr. Pam
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