The safety of a home birth has been debated for a long time. But, if you think about it, mother nature never really intended for us to give birth in a hospital. However, hospitals and doctors can provide a pretty good safety net, just in case something were to go wrong.
Even though giving birth is the most natural thing we can do as women – our bodies were made for it, after all – there are still incredible dangers to both mom and baby. Women and babies still, occasionally, die during labor, even when no complications were predicted and the pregnancy went smoothly.
Still, more women than ever are taking control of their birth plans, opting to give birth at home where they’re most comfortable. As of April 2017, The American College of Obstetricians and Gynecologists estimate that a little less than 1% of United States births take place at home each year, which equals about 35,000. About ¾ of those are planned by women who want control of their experience without the intrusion of hospital staff and monitors.
Doctors and other medical professionals often attempt to talk women out of a home birth. Most of the reasons they give are good points to consider, like unexpected complications during labor that can harm mom or baby. Others are a bit more on the selfish side.
This article simply brings to light some of the reasons a doctor may advise against a home birth, so women can make an informed decision. But, whatever you choose, it’s your body, your baby, and your baby’s birth to experience, so do it in the way you feel most comfortable with.
Some people tell you to rush to the hospital as soon as you feel contractions getting closer together. Others say it’s okay to wait until you feel it’s time to prevent the possibility of getting induced or other medical interventions you don’t want. So, which is it?
Many doctors agree that it’s okay to wait at home for a while, as long as you’re comfortable doing so. The first stage of labor, which is when you feel the contractions that are dilating your cervix, can, in most cases, be done on your own. Some women choose to sit in water to ease the pain, others walk, and others find positions that can help reduce the pain of contractions.
But, once contractions become super intense and are 5 minutes apart or less, those doctors often agree that it’s safer to head to the hospital. Their reasoning behind this is that if something were to go wrong and you need an emergency c-section, the delay to get to the hospital can have devastating effects on you or your baby. So, most are okay with laboring at home until you get close to the second stage of labor; then it’s time to move on out.
Doctors are armed with this awesome thing called malpractice insurance. Some midwives do, too, but many of them also don’t. Malpractice insurance premiums for midwives has skyrocketed, and it’s causing many of them to go without. Even if they have their business covered, they, as individuals, are not covered.
So, if something goes wrong with your labor and delivery at home, it may be solely on you to deal with the costs. In contrast, giving birth at a hospital means the hospital covers you in the event that a medical disaster occurs.
Of course, this can be remedied by finding a midwife (or even a doctor who will deliver at home, but there aren’t many) who remains responsibly covered to help protect his/her patients. Always ask these important questions before deciding on anyone so you can protect yourself and your baby if the least expected happens.
When it comes to birth, you should always be prepared to expect the unexpected. Some women plan to have c-sections, whereas others try to avoid it at all costs. However, our bodies and our babies sometimes have other plans, forcing us to have an emergency c-section no matter how badly we don’t want one.
About 1/3 of labors result in a c-section. Of course, not all of these are due to emergency, but some are. Some of the reasons your labor might end up in a c-section are your baby’s head being too big for the birth canal, labor stalls to dangerous time constraints, your cervix isn’t dilating properly, signs of fetal distress, or you become too exhausted. If any of these occur during your home birth, you may need an emergency c-section.
The problem is, every second counts when it comes to an emergency c-section. Once you get to the hospital from your home, there may not be enough time to numb you and you’ll instead be placed under anesthesia. And of course, there may be dangers to the baby from the delay, especially if he’s wedged in the birth canal or has a prolapsed umbilical cord.
Doctors want to make sure you’re as prepared as you can be for birth, and they’re not always sure that women are as prepared for a home birth as they think. In other words, if you don’t have a solid understanding of what to expect during a home birth and what could possibly go wrong, doctors may be leery about giving you the okay.
However, if you really seem to know your stuff, have asked all the questions, and done your research to find the best midwife for you and your baby, you may be able to impress the naysayers. It’s all about learning the pros and cons of both options – home and hospital birth – and feeling confident that you’ve chosen the best one for you.
Make sure you’re fully prepared for a home birth. Look into your options for pain management, labor positions, and anything else that you need to know about the process. If you’re completely informed, then there’s not much a critic can say about your decision.
One of the biggest draws to the hospital for birth is its sterile environment. There’s no dirt, grime, or clutter to get in your way so you can focus on your labor and delivery. You don’t even have to worry about the messy cleanup afterward. Of course, for other women, this is one of the biggest draws away from a hospital birth.
Not that they want to birth in filth, of course. But they like the idea of giving birth in a comfortable environment that they’re familiar with. Something cozy, with their own blankets, pillows, clothing, and whatever else will soothe them during their birthing experience.
But, if special precautions aren’t taken in the home during delivery, you or your baby can be at risk for infection. Always ask your midwife or provider what methods will be taken in your home to ensure your delivery is sterile and safe, such as how baby’s cord will be cut and tied.
Episiotomy is one of the most dreaded words a pregnant woman can ever hear. The procedure involves your doctor making a small incision ‘down there’ to help baby come out if he feels there is a risk for a massive tear due to a large head or body size. It’s not something any of us want, and fortunately, they aren’t used as much as they used to be. Still, sometimes a delivery warrants one.
Most midwives don’t perform episiotomies, so if you’re having a home birth and need one, you could be out of luck. This could lead to excessive tearing that could have been more controlled by an episiotomy. But then again, episiotomies sometimes lead to excessive tearing as well, so this reason doesn’t hold a lot of weight.
To reduce the risk of needing an episiotomy, you can perform a perineum massage on your area while sitting in a warm bath for a few minutes per day as you get closer to labor. This can help promote stretchiness of the area, resulting in a lower risk of tearing.
Many doctors feel much more comfortable with births in the hospital if you’re expecting twins or other multiples. Pregnancies with multiples carry greater risk of preterm labor or other complications than those of singleton babies, so a hospital birth is preferred in case of an unexpected complication.
However, if you’re close to term and both babies are in position (head down), risks of complications are much lower. Also, it’s best if both babies are delivered within 15 minutes of each other, so if your midwife has an awesome track record and you feel totally confident that she can handle the job, then you may be safe.
Still, with multiples there are much bigger risks for unexpected complications, so it may be wise to get to the hospital once you get close to active labor. The truth is, you have no way of knowing for sure what problems may arise, and it’s best not to take chances.
Many doctors strongly advise against first time moms choosing a home birth. Studies have shown that first time moms are more than twice as likely to suffer complications during birth than those who have already had a child. One English study on home births found that almost half of its participants (all first time moms) had to be transferred from home to the hospital due to risky complications.
In addition to complications, home births resulted in three times more baby deaths at birth or in the first week of life, broken bones, nerve damage, and even bran damage than those who gave birth in the hospital. It’s thought that many of these babies would have been saved from harm had they had access to a c-section at the hospital in time.
However, there are plenty of studies also proving that home births for first time mommies can be safe, so long as they are planned out and everyone involved knows how to best handle an emergency situation.
Have you had any pregnancy complications so far? High blood pressure, gestational diabetes, or placenta previa, perhaps? These are all concerning complications that may warrant a doctor to advise against having a home birth.
The reason behind this is that these types of pregnancy complications are already putting you at more risk for complications during labor. Conditions like these are ones that doctors want to monitor to make sure they aren’t having adverse effects on you or your baby.
Placenta previa, for example, is continuously monitored through pregnancy and delivery because it has the potential to cause extensive bleeding, which is a huge concern if you’re having a home birth. Gestational diabetes can cause abnormally large babies, which sometimes warrants an emergency c-section. High blood pressure needs to be monitored through labor and delivery and may result in dangerous preterm labor.
If you’ve had any serious pregnancy complications, it may be best to err on the side of caution and take advantage of a hospital’s medical team.
Doctors get a little finicky about home births simply for the fact that they worry that moms have no other plan in case something were to happen that’s out of anyone’s control. Of course, we know most of you awesome mamas have Plan A and Plan B (and maybe even a C and D in there somewhere). But, it’s understandable when mamas who are so dead set on having a home birth that they fail to think of other scenarios and haver other plans in place can make a doctor a bit skeptical and nervous.
So, the best thing you can do if you’re having a home birth is think of Plan B. What if something went wrong just before you were about to push and you had no choice but to go to the hospital? Come up with worst-case scenarios and how you would handle them so nothing can come as a surprise at the worst moment.
A 2005 study showed that about 12% of home births end up transferring to a hospital anyway because of a dangerous complication. So, your doctor may see it as, “Well, you may end up here anyway, so why not just start here to begin with?”. To play devil’s advocate, they sort of have a point. Twelve out of 100 home births end up at the hospital, and some of those moms don’t get there fast enough to fix the problem before it’s too late. That’s scary.
But then again, if you’re fully willing to take that risk – and believe you live close enough to a hospital to get there in record speed, should something go wrong – then it’s your choice. All a doctor can do is advise against something, but he can’t take away your permission like a parent scolding you as a child. So, again, prepare yourself, set up a backup plan, and don’t feel like a failure if you end up at the hospital. It’s there to make sure you and baby are safe, and that’s a wonderful thing.
A 2015 study showed higher death rates in babies born from planned home births than those born from planned hospital births. For home births, 3.9 out of 1,000 babies passed during or after birth, whereas 1.8 out of 1,000 babies born in the hospital passed. Neonatal seizures were also more common in babies born at home. Another study showed that babies born at home were more at risk for death within their first 28 days of life than those born in the hospital.
However, these studies found no cause-and-effect relationship, so it’s difficult for anyone to pinpoint that home births lead to more deaths. We don’t know the circumstances leading up to the deaths, so it’s more of a coincidence. But, don’t be surprised if doctors use these statistics to prove their points. They are, in fact, true statistics, but you can always point out that the reasons for the deaths are unclear.
Before you decide on a home birth, make sure it’s legal. Don’t worry, a home birth itself is legal in all 50 of the United States. However, the way your midwife does it may not be legal, so you really need to do your research.
First, find out the laws in your states. There are currently 27 states that require special licensing or regulations for midwives, and if your midwife isn’t current with the requirements, then she could be performing your home birth illegally, which is pretty scary when it comes to such a big moment for you and your child. Also, some states prohibit midwives from handling certain situations, like a breech birth. If that’s the case in your state and your baby is in the breech position, your midwife will not be able to deliver your baby.
The last thing you want is for your delivery to turn into a legal mess, so make sure you stick to a midwife who is legally allowed to practice within your state’s laws.
If you go into labor before the 37-week mark, it’s considered preterm. Preterm labor is risky, even if you’re close to that week, because your baby still needs some time to develop strong organs, like his heart and lungs, which grow rapidly in the last couple of weeks. The longer he stays in your uterus, the better, even if you’re dying to get him out.
If you planned a home birth and you end up going into labor earlier than 37 weeks, it may be best to head to the hospital rather than try to have the baby at home. Sometimes, doctors are even able to stop a premature delivery by giving you an IV medication that can calm your uterus, causing it to stop contracting. They can also give medicine that will help baby’s lungs develop more quickly, just in case you do end up delivering early.
It’s important with preterm labor to get these interventions, if possible, to keep baby baking away until it’s safe for his arrival.
Of course, one of the biggest issues against home births is that there’s no money in it for doctors and other hospital staff. This isn’t to say that doctors are money hungry, but hey, we’re presenting all sides of the coin here, and this is a legit reason for some.
Pregnancies and deliveries are expensive. Prenatal care can cost upwards of $5000 and a delivery averages around $3500. If you have a c-section instead of vaginal delivery, that cost can go up another $1000 or more. That’s a whole lot of money for doctors and the hospital when you consider that most hospitals have at least a few deliveries each day. If you elect a home birth, there goes the hospital's money out the window.
So, yes, some doctors may be more concerned with a paycheck than your decision, but others do have some legitimate concerns over home births. No matter what, it’s your labor, delivery, and baby. You make the final say. Just make sure you’re prepared every step of the way.
Sources: ACOG.org, BabyMed.com, DailyMail.co.uk, NaturalFamilyToday.com, NYTimes.com, Parents.com, WebMD.com,dfwbirthphotographer.com