Is Planned Home Birth Safe

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Is a planned home birth safe

Several reliable studies published since 2010 show that a planned home birth in the United States is unsafe for the newborn baby with an increased risk of neonatal injury and deaths. 

What is an at home birth?

A home birth or homebirth is a childbirth in a non-clinical setting at home. It is a delivery that takes place at home, in a residence rather than in a hospital or a birth center. A planned home birth is a homebirth that has been planned while an unplanned home birth is a birth at home that was not planned.

What is an out of hospital birth?

An out of hospital birth is a birth that happens out of the hospital, in a residemce at home, in a birthing or birth center, or anywhere else besides the hospital 

Home births in the United States

In the United States, over 98% of all births take place in the hospital. Only about 1% of deliveries are home births, though about 1/3 of these are home births without an attendant, usually family, ambulance, or taxi driver. So much less than 1% of births in the US are planned home births. A planned home birth is usually attended by a certified nurse midwife (about 1/3 of the time)  or a "direct-entry" midwife (2/3 of the time) who was not trained as a nurse, such as a CPM or in some US states a licensed midwife.

Home birth studies shows more neonatal deaths and adverse outcomes 

A study by Dr. Grunebaum showed that there is a nearly 4-time neonatal mortality risk with home births. Another study by Dr. Grunebaum showed that home births are associated with over 10-times the risk of Apgar scores of zero (virtually dead babies) when compared to doctor led hospital births and nearly 18-times the risk of midwife hospital births. These adverse outcomes may be due to the fact that in the US there are no guidelines for risking out homebirth patients, and the results are that there are increased risks in homebirth deliveries.

In a 2017 study there were 2 additional risk factors identified that increase a baby's risk at home birth for a total of 5 risk factors:

  1. First baby
  2. Pregnancy 41 weeks and over
  3. Prior cesarean
  4. Breech
  5. Multiples (twins, triplets)

Safety of having a baby

Having a baby is mostly about safety, both for baby and the mother. Interventions such as cesarean sections can be life saving especially when minutes can make a difference. Cesarean sections are not available in homebirths.  

A little over 100 years ago 10 in 100 children died before the age of 1 years of age as compared to today with less than 1 in 100 children dying. Similarly, about 60-90 per 10,000 women died of childbirth related complications as compared to less than 1 in 10,000 today, a more than 99% decrease!

  • The risk of dying from a gun in the US is 1 in 24,000, while the risk of a baby dying from a home birth is 24-times of that risk, over 24 in 24,000 home births.
  • 1 in 750 babies die during homebirths while 1 in 24,000 are killed by guns and 1 in 57,000 died driving a Cobra car which was recalled. What is more dangerous?

When comparing interventions between hospital and home births, it is  important to  compare data of uniformally published data on worse neonatal outcomes of the baby during home births. There is unquestionably a higher risk of low Apgar scores and more neonatal deaths and injuries to the baby with a home birth.
Women contemplating a home birth should be made aware that the newborn is over 3 times more likely to die during a home birth, and the risk increases further if this is a woman's first baby or if the pregnancy is over 41 weeks. 

True feelings about home births

Yes, I regret my home birth. Yes, I do not want anyone to make the same mistake I did.

On Saturday 3/20/2015 a woman at 41w4d who was attempting a homebirth after two prior cesarean sections was admitted to the hospital with a stillbirth and a ruptured uterus. Her midwives worked for