Home birth: Know the pros and cons

If you're considering a planned home birth, you probably have questions. Is it safe? Will you need a midwife or doula? How do you create a backup plan? Find out what's involved in a planned home birth and how to decide if this birthing method is right for you.

What happens during a planned home birth?

During a planned home birth you'll give birth in your home instead of in a hospital or birth center. You'll be assisted during labor and delivery by a midwife or, in some cases, a doctor. During your prenatal care your health care provider will review a list of conditions during pregnancy and labor that would require treatment by a doctor and compromise the safety of a planned home birth. Your health care provider will also review the challenges that can occur during childbirth, how he or she — in comparison with a hospital — would handle them, and the possible health risks for you and your baby.

During labor, your health care provider will periodically — rather than continuously — monitor your temperature, pulse, blood pressure and your baby's heart rate. After delivery, you'll be close to your baby. Your health care provider will examine your newborn and determine whether he or she needs to be transferred to a hospital. In addition, your health care provider will give you information on how to care for your newborn. Follow-up care might include home visits and lactation support.

Why do women choose planned home births?

You might choose a planned home birth for many reasons, including:

• A desire to give birth in a familiar, relaxing environment surrounded by people of your choice
• A desire to wear your own clothes, take a shower or bath, eat, drink and move around freely during labor
• A desire to control your labor position or other aspects of the birthing process
• A desire to give birth without medical intervention, such as pain medication
• Cultural or religious norms or concerns
• A history of fast labor
• Lower cost

Are there situations when a planned home birth isn't recommended?

A planned home birth isn't right for everyone. Your health care provider might caution against a planned home birth if you:

• Have diabetes, chronic hypertension, a seizure disorder or any chronic medical condition
• Previously had a C-section
• Use tobacco or illegal drugs
• Develop a pregnancy complication, such as preeclampsia, preterm labor or significant anemia
• Are pregnant with multiples or your baby doesn't settle into a position that allows for a headfirst delivery
• Are less than 37 weeks or more than 41 weeks pregnant

What might cause the need for a hospital transfer?

During a planned home birth, you might need to be transported to a hospital for monitoring or treatment. Your health care provider might recommend transfer to a hospital if:

• Labor isn't progressing
• Traces of fecal waste (meconium) appear in your amniotic fluid
• The placenta peels away from the inner wall of your uterus before delivery (placental abruption)
• The umbilical cord drops into your vagina ahead of the baby (umbilical cord prolapse)
• You have vaginal bleeding not associated with bloody show — a thick plug of mucus that blocks the cervical opening and falls out when the cervix thins and opens
• You don't deliver the placenta or it's not delivered intact
• Your baby shows signs of distress, such as an abnormal heart rate

What are the possible risks of a planned home birth?

While most pregnant women who choose to have planned home births are at lower risk of complications due to careful screening, planned home births are associated with double to triple the risk of infant death than are planned hospital births. Still, even with that increase, the overall risk of infant death is low.

How do I prepare for a home birth?

You can prepare for a planned home birth by:

• Choosing a trained health care provider to assist. Choose a certified nurse-midwife, a certified midwife or a doctor who has a formal relationship with a health care system overseen by your state health department or the Joint Commission. Make sure he or she has easy access to consultation with doctors or specialists at a collaborating hospital, if necessary. If you're interested in additional physical and emotional support, consider hiring a doula — a professional labor assistant.
• Creating a birth plan. Where do you plan to experience labor and delivery? Will you use any specific methods, such as Lamaze, to cope with pain? Do you plan to have a water birth? Will you breast-feed your baby immediately after delivery? What other family members or support people will be present? Be sure to discuss the details of your birthing plan with your health care provider. Ask your health care provider what kind of supplies you'll need to provide, such as towels, sheets or other protective coverings for your floor or mattress.
• Preparing for a hospital transfer. Discuss with your health care provider the signs and symptoms that might necessitate going to a hospital and how a hospital transfer will affect your birthing plan. Ideally, your home or other planned birth location is within 15 minutes of a hospital with 24-hour maternity care. Make sure you have access to transportation. Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly transferred and treated, if necessary.
• Choosing a pediatrician. Plan a medical exam for your baby within a few days of birth.
• Arranging for postpartum help. After delivery, you might need help caring for yourself and your new baby. Arrange for family or friends to help. A doula can also provide postpartum support.

What else do I need to know about a planned home birth?

With careful planning, a home birth can be a positive and rewarding experience. Keep in mind, however, that life-threatening problems can occur during labor and delivery without warning. In those cases, the need to transfer you and your baby to a hospital could delay care, which could put your lives at risk. Understanding the risks and benefits of a home birth can help you make an informed decision about how you plan to give birth.

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