Respect women’s choice to have home birth: doctors

Although hospitals and birthing centers are the safest places to have a baby, pediatricians said today that women who choose to give birth at home should be supported and that setting made as safe as possible, as well.

Planned home birthing, they said, may be an option for healthy moms-to-be who are due to have a single, on-time baby. A certified nurse-midwife, midwife or doctor should be present and a previous agreement made with a nearby hospital in case transfer is needed, according to the American Academy of Pediatrics (AAP) policy statement.

Its Committee on Fetus and Newborn wrote Monday that less than 1 percent of all births in the U.S. are homebirths, but that rate has been increasing among white women in recent years.

“The experience of having a baby is very different at home than it might be in a birthing center or a hospital,” said Dr. Kristi Watterberg, the policy statement’s lead author and a pediatrician and neonatologist at the University of New Mexico in Albuquerque.

“We would like to help foster professional interactions and support systems that could make every baby’s chances the best they can be.”

The issue remains hotly debated, but evidence suggests that most home deliveries go well. Home births have been linked to about one extra infant death for every 1,000 live births, according to the statement published in Pediatrics. Past reports suggest between 10 and 40 percent of women are transferred to a hospital before delivery due to unexpected complications - but most of those aren’t emergency transfers, Watterberg noted.

It’s not completely clear what’s responsible for the small increase in deaths among home-birthed babies, said neonatologist Dr. Michael Malloy, from the University of Texas Medical Branch in Galveston.

His own research has suggested close to half of babies who don’t survive a home birth had a birth defect, but some may also die from asphyxia - and could have been saved with faster help.

The new statement is in line with a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG), which said it “respects the right of a woman to make a medically informed decision about delivery.”

Watterberg said that because there are such strong emotions around the topic of home birth, women have to make sure they sort through those different views carefully.

“It’s important, as a potential mother, to make sure that your care provider understands what your thoughts are, what your position is, and that you in turn understand what to expect from either a hospital delivery or a home delivery,” she told Reuters Health.

There are some instances in which a home birth might not be the best idea, Watterberg added, such as for women who don’t live near a hospital - or if there’s a blizzard in the forecast.


Mairi Rothman, a midwife, said one of the problems with the debate on home birth is that people aren’t talking about the risks that come with delivering in the hospital.

“For example, you have a much higher risk of having cesarean (section) in the hospital, you have a much higher risk of having anesthesia,” said Rothman, who serves on the board of directors of the American College of Nurse-Midwives.

At home, she told Reuters Health, “there’s no hospital-acquired infection, there’s no mixing your baby up with another baby, there’s much more support (for breastfeeding).”

Rothman said the data suggesting home births result in more infant deaths are skewed by the inclusion of babies that were born at home accidentally - such as when a woman goes into labor prematurely or didn’t know she was pregnant.

“I can tell you with complete confidence, there is nothing in a birth center that I don’t bring to a home birth,” she said - including resuscitation equipment, oxygen, sutures and an IV set-up.

“What we’re essentially doing is setting up a birth center in someone’s home.”

Malloy, who wasn’t part of the AAP committee, said he agrees with the gist of the statement.

“It still allows for the woman to make her own decision, but hopefully it’s an informed decision,” he told Reuters Health.

“I don’t think the intent here is necessarily to scare women off from having a home delivery, but they just need to be aware of the risks associated with doing so.”

SOURCE: Pediatrics, online April 29, 2013

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