Your Guide to Home Birth

More and more pregnant people are considering home birth, a practice that for centuries was the only way people gave birth. Today, many parents contemplate home birth because they want to avoid a hospital's high-tech atmosphere and medical interventions, such as drugs to speed up labor or having an epidural to relieve pain. Others prefer the lower cost, freedom, and ability to spend labor with loved ones comfortably at home.

While there are important risks to consider, planned and assisted home birth is a valid, legal option for those who are good candidates. Home birth is an especially good fit for those with low-risk pregnancies, particularly if they have given birth before. Read on to help understand if home birth is right for you.

Who Can Have a Home Birth?

According to the American College of Nurse-Midwives (ACNM), home birth should be an option for generally healthy people with uncomplicated pregnancies. That means if you have chronic medical conditions (such as heart disease or hypertension) or pregnancy complications (like preeclampsia, placenta previa, or gestational diabetes), home birth may not be a safe option.

In addition, the American College of Obstetricians and Gynecologists (ACOG) lists the following as criteria for appropriate candidates for home birth:

• You have access to a certified nurse–midwife or certified midwife 
• You live near a hospital in case you need to transfer
• You go into labor between 36 and 41 weeks gestation

Since medical emergencies sometimes arise, even in healthy people and uncomplicated pregnancies, having a certified midwife helps ensure red flags are caught early. Relatedly, getting to a hospital quickly in an emergency is critical. So, if you live near a hospital, that is most optimal in case of the need to transfer care.

Alternatively, you can choose to give birth at a birthing center or plan to go to a friend's or relative's house that's closer to an emergency center.

Who Should Not Have a Home Birth?

ACOG guidelines state the following conditions are also not considered safe for home birth:

• Carrying multiples (being pregnant with more than one fetus)
• Vaginal birth after a C-section (VBAC)
• The baby is in a less-than-optimal position (like breech presentation)

According to ACOG, these types of pregnancies increase the risk of needing medical intervention and are safer in a hospital.

The Benefits of Home Birth

While every birth is unique, studies have found that people who have a planned home birth often report high levels of satisfaction with their birth experience. Home birth also offers a lot of freedom to do almost anything you want, including being in your own home, walking around, showering, cooking food, and watching TV. Plus, you have more uninterrupted bonding time with the baby.

Another benefit is that home birth costs a fraction of hospital birth. However, insurance may not cover it, so your out-of-pocket costs may be higher.

Studies of planned home birth have found the following benefits:

• More likely to be exclusively breastfeeding at 6 weeks
• Fewer inductions or labor augmentation
• Fewer vacuum or forceps deliveries
• Less likely to have epidural anesthesia
• Fewer episiotomies
• Lower c-section rates
• Lower rates of postpartum hemorrhage
• Lower rates of severe perineal tears
• More control over birth decisions
• Feelings of empowerment
• Ability to be surrounded by the people of your choosing, like invited family and friends
  

Researchers point out that these benefits are expected because those having a home birth are naturally lower risk; however, differences remain when studies compare low-risk people with the same health care providers.

People often wonder if having a baby at home makes for a less painful birth. This is very difficult to determine as each person experiences pain differently—and it's impossible to know how their pain sensation might have changed in a different environment. However, for some people, the comfort of being at home may help them to cope with labor pain more effectively.

The Risks of Home Birth

In many cases, home births are successful, but occasionally, complications arise. The main risk of home birth is the inability to reach a hospital in time if an emergency arises.

According to ACOG, home birth is associated with double the rate of fetal death (1 to 2 in 1,000) and three times the risk of neonatal seizures or serious neurologic dysfunction (0.4 to 0.6 in 1,000).

Even if a sound emergency plan is in place, it's important to consider that you could lose valuable time in transit to the hospital if your birth doesn't go as planned. In other words, you won't have immediate access to emergency medical care should you need it.

In fact, one of the risks of home birth in the U.S. compared to other developed countries where home birth is more common is that the U.S. does not have a collaborative, integrated health care system that makes transfers more seamless.

If this is your first birth, the possibility of needing to go to a hospital is much higher than for those who have given birth before. Around 23% to 37% of first-time parents attempting home birth end up transferring to the hospital compared with 4% to 9% of those who have given birth before.

There are also fewer options for controlling labor pain, an issue that first-time parents may not fully appreciate when planning their home birth.

Preparing for a Home Birth

Consider the potential benefits and risks of home birth and how they apply to you. An OB-GYN or midwife can help you with this decision. Once you know that home birth is right for you, it's time to make all the necessary preparations.

Choose a midwife

The most common medical professional people hire to assist in home birth is a certified midwife with tools, training, and expertise. When interviewing candidates, ask how many births they've attended, both as a primary (where they were in charge) and as an assistant.

Chris Ann Beard, a certified nurse-midwife in Portland, Oregon, says you want someone who's been the primary birth attendant in at least 100 births. Also, ask if the midwife works with an assistant.

Also, make sure the practitioner is comfortable handling emergencies. Ask specific questions about the range of complications they've handled. Your midwife should have the knowledge and equipment to resuscitate a newborn, administer medication to stop a postpartum hemorrhage, and suture a severe laceration.

In case of such emergencies, your midwife should bring the following:

• IV fluids
• An oxygen tank
• Oxygen masks for various sizes of infants
• An oxygen delivery device suitable for adults (in case you need one)
• Suturing materials

To find a midwife who does home births, check out the Midwives Alliance of North America website. Word of mouth can also be a good method for finding a trusted midwife.

Get acquainted with a hospital

Some home birth patients have their prenatal lab work and ultrasounds completed through a doctor's office (often an OB-GYN or their primary care health provider). That way, your insurance is put to use, and if you are transferred to the hospital, your medical records are already on file.

Ideally, your midwife should also have a relationship with a physician or hospital. That way, if the home birth doesn't go as planned, your care at the hospital will be more streamlined. If your midwife doesn't have a doctor they work with, they can call to describe what's happened and warn of your arrival, but you'll basically be treated as an ER patient, says Beard.

Without a midwife-doctor relationship, the hospital staff won't know anything about your medical history and will likely have concerns about you and your baby. This often results in more tests and interventions—things many birthing parents hoping for a home birth want to avoid.

Create a birth plan

Think about what your preferences are for your birth and write them up in a birth plan. This plan offers a guide to your birth preferences and helps those supporting you to know your wishes. This is especially important because, during the throes of labor, you may be unable or inclined to explain your preferences.

Writing the document also becomes a vehicle for discussion and reflection. You'll want to consider each element of the birth, including the following:

• Do you want to record your birth?
• Do you want to use your tub?
• How mobile would you prefer to be?
• How will you feed your baby?
• How will you get to the hospital (and which one), if needed?
• If breastfeeding or chestfeeding, when will you start?
• When you will consider pain relief, and what kinds do you want to try?
• Who would you like to cut the umbilical cord (and when)?
• Which birthing positions would you like to use?
• Which room or rooms would you like to labor in?
• Who you would like to be present?
• Would you like music to be played?
  

Go over your birth plan with your health care provider. They can help you adapt your plan, as needed, to your specific situation. Then, everyone will be on the same page when the big event happens. Just remember that a birth plan is never set in stone, especially in the event of an unforeseen circumstance or an emergency.

Gather necessary supplies

Since you won't be at a hospital, you'll need to ensure you have everything you'll need for the birth. Check with your midwife to confirm what they suggest you have at the ready (most will give you a list). They also may bring some of the supplies you'll need. However, a basic list includes the following:

• Baby supplies, such as baby wipes, newborn diapers, and newborn clothing
• Bucket (in case you throw up)
• Ice chips
• Ice packs
• Light, easily digestible snacks, such as popsicles, clear broth, and toast
• Loose, comfortable clothing
• Over-the-counter anti-nausea medication and pain medication, such as ibuprofen or acetaminophen
• Overnight menstrual pads
• Pillows (and waterproof pillow covers)
• Towels in a variety of sizes
• Water bottle
• Waterproof pad or plastic sheet (to protect your mattress or wherever you labor)
  

Packing a hospital bag just in case you need to transfer is also a good idea.

Preparing for a Transfer to the Hospital

While no one planning a home birth likes to think about a hospital transfer, it's a good idea to be prepared in case it's necessary. Identify which hospital you will use if you need to transport and have a bag packed and ready. Also, discuss with your midwife how often they transfer care during labor and which situations they find transfers necessary.

Studies have found that transfers from home to hospital occur between 9.9% to 31.9% of the time. Of those, up to 5% are considered emergencies.

According to ACOG, people who attempt home birth but eventually go to the hospital do so most often because of the following:

• Slow or stalled labor
• Concerns about the baby's health
• Need for pain relief
• High blood pressure
• Bleeding
• When the baby is not in an ideal position for delivery

Rest assured that, more often than not, home births go as planned, particularly for people who have low-risk pregnancies. However, there are a variety of issues that will preclude you from attempting or continuing a home birth, most of which are out of your control. So, being prepared for those can help you feel more secure if a situation, however unlikely, does arise.