Stay Wild: The Safety of Homebirth
Wilder Midwife Jessi here! One of the reasons Meredith and I have been so excited to launch our practice this Fall is because we feel so passionately about home birth and have greatly missed it over the last little season of our midwifery careers.
We recently did a home birth in rural Oregon City, and the setting COULD NOT have been more picturesque and gorgeous. Mom labored on hands and knees in a warm birth tub out on her back patio, and baby was born into Dad’s hands just as the sun was coming up over the fields and trees behind the house. It was a magical moment!
As we have started putting together our equipment and getting our practice supplies lined up, people have started again asking us one of the MOST common question we get as midwives:
“But is homebirth safe?”
And here is the resounding answer: YES!
Home birth has been shown over and over agin to be a safe and reasonable option for low risk populations. While the definition of “low risk” may change based on the community standards in your area, this generally includes people who:
Are pregnant with just one baby
Do not have a history of endocrine disorders (like diabetes) or other serious health concerns (such as chronic hypertension).
Have had no complications in this pregnancy
Have no history of serious complications in previous pregnancies (such as uncontrolled gestational diabetes, preeclampsia etc)
Whether or not home birth is a safe option for you is best decided in conversation with a licensed midwife who can advise you on your individual risk factors and health history. But generally, if you are healthy and your pregnancy is healthy - you can consider home birth to be a safe choice.
The Research on Homebirth
In 2014, the Journal of Midwifery and Women’s Health published a research paper based on the outcomes of 16,924 planned homebirths in the U.S between the years 2004-2009. This information was collected by the MANA Statistics project, and looked to see the types of complications that planned home births encountered, and the morbidity and mortality rates among the infants and parents. What the researchers found was that:
““Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia...
Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (<7) occurred in 1.5% of newborns.
Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent...Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively.
Low-risk women in this sample experienced high rates of normal physiologic birth and very low rates of operative birth and interventions, with no concomitant increase in adverse events.””
This research was a big deal when it came out, because it looked at PLANNED home births in the U.S and parents who were using trained and qualified midwives as their care providers. However, it wasn’t the first or last time research has shown the outcomes of home birth to be just as good (if not in some ways better) than hospital or birth center births.
In 2011, the Birthplace in England national prospective cohort study was published which also compared outcomes of planned home births, to birth center and hospital outcomes. These authors found:
“The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.”
There is actually a fantastic visual guide to this research which I recommend to anyone looking to try and make sense of the data and decide where the best place to birth might be! Pages 11-14 especially go into depth comparing the outcomes between 1st time parents and people who have given birth before (be aware - its pretty traditionally gendered). An added bonus of this handout is that the data is represented in picture form - which for a visual person like me is everything!
Finally, in 2019 the Lancet published an article looking specifically at the outcomes of babies whose parents planned to give birth at home, versus those who gave birth in the hospital. This study was a meta-analysis, meaning they took lots of research studies on home birth, complied the data, and gained a bird’s eye view of what the actual risks are. These researchers found that:
“Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital.”
These 3 research studies are just the tip of the iceberg when it comes to research on home birth. There are dozens more studies that have been done in countries such as Canada and the Netherlands, where birth at home with midwives has been established and happening for decades. Home birth has been shown repeatedly to be a safe option for low risk pregnancies.
“But what if, like, something goes wrong?”
Another great question! Sometimes things do get complicated or “go wrong” and we can’t always predict those situations. That’s really why you hire a midwife. Licensed midwives are trained to be incredibly skilled at identifying when labor is normal, and when it is not. We carry loads of equipment with us to births including:
oxygen
medications to stop bleeding
Resuscitation equipment for both mom and baby
IV supplies
And more!
We regularly train on using this equipment and do practice drills to make sure we can handle emergencies in the home setting smoothly. We take our practice really seriously, and while midwifery has been around for a long time - we also stay up to date on practicing safely according to the newest evidence!
We watch closely for signs that home is no longer a safe place to be anymore, and as soon as this becomes clear - we recommend transferring to the hospital. Then, we accompany you to the hospital and remain with you until everything is stable (and usually until the baby is born!).
“The rate of transfer from home to hospital after the onset of labor ranges from 9% to 13%. The majority of maternal and newborn transfers are nonurgent, and the most common reason cited for transfer is failure to progress among primiparous women (78%)”
Most of the time when transfer needs to happen it is non-emergent. And while it doesn’t happen often, it happens enough that we need to talk about it and realistically prepare for the possibility with every client that comes into our care. The birth of my daughter was actually one of these statistics, so I love getting to talk to families about this research and how home birth transfers actually take place (because I experienced one!).
The bottom line: part of what makes home birth safe in the U.S. is our ability to transfer into a hospital for interventions when we need them!
For some people, hospital birth is absolutely the right call, and we work hard to make sure people get the healthcare they need as soon as they need it.
Here in the US more and more families are choosing home-based healthcare for their childbearing year, and there are some GREAT reasons why!
Some Benefits of Birthing at Home
Fewer Interventions – All three of the research studies cited above found substantially fewer interventions happening in birth that takes place at home. This makes sense, because there are fewer options for intervention outside of a hospital facility. But let’s not gloss over the implications of this! Researchers found fewer cesarean births, instrumental births (which include episiotomies, forceps, and vacuum-assisted births), inductions, pitocin labor augmentation, and medication use. All of these interventions carry inherent risk. We are so grateful for them when they are needed, but a reduction in their use also results in a reduction in the side effects and problems these interventions cause - 100% a good thing!
Your Healthcare Provider Comes to YOU – Have you seen those incredible car birth videos going around social media? While I can honestly say I LOVE watching people give birth in their own power, I always feel a little sad that these parents had to go out and get in that car to begin with. When labor is progressing smoothly (and especially when progressing FAST), getting in the car is pretty much the last thing anyone wants to think about. One of the great things about having a home birth is that your midwife is the one getting in the car and coming to you. You get to stay in the zone, doing what feels right as you labor.
You Know Your Midwives – One of the best parts about having the midwifery model of care is that you can get to know your midwives on a deeper level, and you can feel comfortable and confident with them - LONG before the birth is actually upon you. Midwifery visits are typically 45-60 minutes and focus on emotional and mental well-being, as well as physical health. This way, there are no major surprises in their care style during pushing. You know exactly what kind of care you are getting during labor, because you’ve had enough time to establish a solid relationship during pregnancy.
You Get to Stay Wild – We consider your home your natural environment, and if everything is normal and healthy, it makes sense to give birth in your own habitat instead of in an artificial one. We know that mammals have a hard time with the process of birth when they are heavily watched, restricted, uncomfortable or afraid. Staying home with care providers you trust allows you to labor intuitively and naturally, without unnecessary intervention. We believe that there is a power in staying home in your own environment - YOU are the ones calling the shots in your home. And this subtle shift in mindset can allow birth to become an empowering family experience.
Want to know more about home birth or have questions on the safety and research? Lets talk! Comment your questions down below and I will do my best to answer them.
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