I very much believe in a woman’s right to choose where she gives birth. I also believe that the vast majority of homebirths are uncomplicated and Certified Nurse Midwives are well-qualified to manage most complications that do occasionally occur. With informed consent and qualified care providers, homebirth may be the right choice for many women. However, to me, it’s just not worth the small risk of a catastrophic complication occurring that could have been managed in the hospital setting but that is deadly at home without an operating room and full medical team.

Recently I had the opportunity to attend a homebirth. This was the mother’s third pregnancy, and each of her previous two had also been uncomplicated. She was the perfect homebirth candidate. Her labor was short and intense, and after just a few minutes of pushing in her bathtub, a healthy baby boy was born. The Certified Nurse Midwives that attended the birth were extremely attentive and charted constantly. The woman’s other children were also able to participate in the birth and share in the special moment. It truly was the perfect homebirth experience and it made me realize exactly why so many parents make this choice.

This is clearly not the story of a homebirth gone wrong. Actually, it’s quite the opposite. But even though there was no sign of danger throughout the labor and delivery, I couldn’t help but wonder in the back of my mind exactly what would happen if there was. This mother lived close to a hospital, but when seconds count, the distance from the hospital is unimportant. The CNMs were well-equipped with emergency equipment and medications, but in some cases, an operating room is the only thing that can save mom and baby. While witnessing a homebirth opened my eyes to its advantages, it also raised many questions as to how an emergency would be handled without an operating room and full surgical team.

It is not uncommon for me to see a complication occur at the hospital that I realize may have been deadly for either mom or baby at home. Whether it be a sudden fetal heart rate deceleration that doesn’t come back up or an undetected placenta accreta that causes massive hemorrhage, there are certain conditions that need to be managed within minutes, and the time it takes to move from home to the operating room does not fall into that critical time frame. Each time I see one of these complications, I am grateful that this family chose to give birth in a hospital where it could be quickly managed and a potential tragic outcome can be avoided.

There are too many unknowns when it comes to pregnancy, labor and delivery. It doesn’t matter how low-risk a woman’s pregnancy is or how many successful labors she’s had in the past for complications like cord prolapse, fetal distress or massive postpartum hemorrhage to occur this time around. Though these complications are rare and the vast majority of homebirths with a qualified care provider turn out well, I would still be very hesitant to encourage anyone to take the small risk of a bad outcome that would have been prevented in the hospital. The peace and comfort of a homebirth is an advantage that cannot be overlooked, but to me, the risk just isn’t worth it.