· Maternity Care ·
In 2009, a large study was done in Canada of 6,692 low-risk women planning home birth at onset of labor. These women were compared to a similar-risk group of women planning hospital birth. Compared with the hospital group, women planning birth at home had lower rates of serious maternal morbidity (illness) and lower rates of all interventions, including cesarean. There was no difference between the groups in rates of serious illness or death of the newborn.BIRTH 36:3 September 2009
Birth at home may be a good option for you if you:
- Have a low-risk pregnancy
- Desire to minimize use of medical interventions in labor/birth
- Plan to not use pain medicine in labor
- Have strong social support through family and/or friends
- Want the option of waterbirth
- Have a home environment supportive of birth
While home birth has been around since the beginning of time, it fell into disfavor in the United States in the twentieth century. Physicians began to replace midwives at birth, and women began going to hospitals to have their babies. People began to view hospitals as the safest birth environment. Many studies do not support this belief. Birth at home with a trained attendant and the appropriate supplies is at least as safe as hospital birth.
There are some special preparations to make for a home birth. Your midwife will give you a list of supplies to gather as you prepare. There is also a kit of disposable items that is purchased prior to the birth. A few weeks before your due date, a midwife makes a visit to your home to help you finalize preparations. You will also discuss newborn care and postpartum danger signs prior to the birth of your child.
In the Netherlands, 30% of women give birth at home under the care of a midwife. A very large study of approximately 530,000 low-risk women was done in 2009. There were no significant differences found in perinatal illness or death between those women planning home birth and those planning hospital birth.de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x
On the day of labor, your midwife comes to your home when you are in active labor. She listens to the baby's heart at regular intervals, and also monitors your own health and progress throughout labor. She offers her expertise in helping you cope with labor. Natural methods commonly used for pain relief include water immersion, Transcutaneous Electrical Nerve Stimulation (TENS), homeopathics, aromatherapy, acupuncture, cold/hot packs, acupuncture, massage and relaxation techniques. When the baby is near to being born, a second trained professional comes to assist with the birth and recovery. This second person is usually another midwife or a nurse trained in labor and delivery.
The midwife brings many supplies to the birth, including those for emergencies. Some of these items are: emergency medications for seizure or hemorrhage, resuscitation equipment for baby and mom (including oxygen tank), IV fluids, suturing supplies (and numbing medicine) for placing stitches, baby scale, and newborn medications.
After the birth, the midwife stays with you for three to six hours. Breastfeeding is started shortly after birth, and a newborn exam is done. Before your midwife leaves, she will make sure you and your baby are physically stable. You will be able to walk around, use the bathroom, take a shower, and eat a meal. The midwife also ensures that the house is as tidy as when she arrived and that the laundry is started. She will then review with you what to expect over the next day and danger signs for which to call.
A study of 6,044 planned home births in Great Britain found no difference in death rates or newborn outcomes compared to hospital birth. However, women planning birth at home experienced significantly less medical interventions and complications.Chamberlain G, Wraight A, Crowley P. Home births: Report of the 1994 confidential enquiry of the National Birthday Trust Fund. Cranforth, UK: Parthenon; 1997.
Throughout the course of labor, birth and recovery, your midwife is continually assessing the safety of you remaining in a home setting. If medical risk factors develop that are better handled in a hospital, she will help you get to the appropriate place for care. Usually the "transfer" occurs in a non-urgent manner by private car. In the rare event of an urgent transfer, an ambulance is used for transportation to the nearest hospital with full obstetrical service. We most commonly transfer to the University of Washington.