Home Births- Pros and Cons, Is This For You?

HomebirthMy mom is a retired Certified Nurse Practitioner, who was a pioneer in the home birth movement during much of her career.  She was very involved in getting lay mid-wives trained and certified.  Watching her and hearing her stories, I was able to witness both the good and the bad of home births.  Being a pediatrician, I see the good and bad of the hospital medical care involved with delivering in the hospital. 

The short version of pros and cons is this:

Deliver at home and you have a much less likely chance of a C-section. About 1/3 of hospital deliveries are now by cesarean section, certainly not natural childbirth. Deliver at home and there is a slightly increased chance of death to both mom and newborn.   When complications do arise, be it hemorrhages of the mother, or group-B strep infection of the infant, for example, you clearly have benefits by being in the hospital.  The AAP Policy Statement on Planned Home Birth (Read Here) claims that there is a 2-3 times increase in infant death of 1/1000 for home births. 

From the Obstetrical side, the key if you are going to plan a home birth, is that you have a certified and trained midwife who knows which higher risk pregnancies should NOT be delivered at home, and have an emergency plan to get you to the hospital fast in the case of an emergency. If it would take you more than 20 minutes to get to the hospital, you are at greatly increased risk of bad outcomes in the event of an emergency. 

From the pediatric side, there are several considerations.  There needs to be a person at the delivery whose job it is to attend to the baby if there is a problem.  Be prepared for that rare event where both mom and baby need help right as the baby is delivered. Group-B strep positive moms, you do have increased risk and that risk goes way up if you have rupture of membranes many hours before delivery. There should be a way to screen the baby’s glucose if there are risk factors or if the baby is jittery or not feeding well. Plan to get the baby to the hospital if the glucose level is than 45.

I recommend Vitamin K for the newborn.  If mom is Hepatitis B negative, unlike most of my peers, I do not see the wisdom of injecting 250 micrograms of aluminum by giving a newborn the Hepatitis B vaccine at this time.  That vaccine can be given at school age or pre-teen. 

As with all decisions in medicine, weigh the risks and benefits of each decision.  It may make sense to have a home birth, but it may also make sense to have your birth in a birthing center with trained, certified nurse mid-wives, or in a hospital setting where you may also be able to have nurse mid-wives attending.  If you do try a home birth, don’t see a transfer to the hospital as failure, but rather as a success in your safety plan. 

 

Dr. Paul

 

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