Is homebirth safe?

Safety has been held up as the reason why all women should give birth in the hospital. This is despite the fact that no data support the contention that homebirth holds any excess risk provided:

• the mother is low risk
  
• the homebirth is planned
  
• she has a trained, experienced birth attendant
  
• there is a modern hospital within a reasonable distance

When would a homebirth be inadvisable?

• When there are risk factors. Homebirth practitioners agree that some risk factors should rule out home birth. The mother having high blood pressure, or the baby coming early would be two of those factors, while they disagree on others such as the mother having a prior cesarean. In the end, it comes down to you making an informed decision based on the balance between the risks you run at home versus the risks you run in the hospital. To make this assessment, you must weigh your particular circumstances and the skills and experience of the homebirth practitioner against the local hospital care available to you.

• When no trained, experienced homebirth attendant is available. Most of the emergencies that arise without warning at a low-risk birth -- the baby's shoulders are stuck (shoulder dystocia); the baby doesn’t breathe; heavy bleeding -- can be resolved or stabilized for hospital transport by a skilled pair of hands and readily portable medication and equipment.

• If you think you will probably want pain medication. You may also feel hesitant or uncomfortable about having a homebirth. No matter what your intellect says, if your gut says “I shouldn’t be at home,” labor may progress poorly. If you plan a home birth, you must be well prepared and confident of your ability to cope with the pain of labor. A difficult labor may eventually lead to transfer into the hospital for, among other things, pain medication, but you shouldn’t start off indecisive about using it.

What other factors should be considered?

• Lack of a smooth, efficient means of transferring care. You may need an obstetrician or care in a hospital during labor or for postpartum complications. In many communities, on the grounds that homebirth is dangerous and should be discouraged, doctors have made it difficult or impossible for homebirth practitioners to work with obstetricians or to transfer their clients to an obstetrician’s care or into the hospital. Ironically, these doctors create a safety issue where none would otherwise exist.

• When there is no back up hospital within a reasonable driving distance that is capable of handling urgent problems. Here’s the dilemma: On the one hand, the ability to get to a hospital in a timely matter may make a difference. On the other hand, a low-risk woman runs risks in the typical hospital that she doesn’t run at home. At home, she would be under close observation by someone who could spot problems early, head most of them off and who wouldn’t potentially be causing complications by inappropriate use of procedures, drugs and restrictions.