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Is planned home birth safe?

Planned home birth in the United States is anything but safe. Many reliable studies show that planned home birth in the United States is unsafe for the newborn baby and poses an increased risk of neonatal injury and deaths. The risk is greater with planned home births attended by midwives when compared to hospital births attended by midwives or doctors. The risks of injury and deaths are also higher for women who have their first baby or who are older. This is confirmed not only by the peer-reviewed literature but also by a newspaper investigation on home births showing the same adverse outcomes.

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Example of an adverse outcome of a planned home birth

A 32-year-old woman goes into labor at home with a nurse-midwife. She labors for 27 hours, and her water breaks, showing meconium-stained amniotic fluid. When the midwife examines her, the midwife finds that the umbilical cord has prolapsed into the vagina, is being compressed and deprives the baby of oxygen. The mother is rushed to the hospital, arrives there within 30 minutes and an emergency cesarean delivery is done, but the baby dies within 30 minutes after delivery from hypoxic (no oxygen) injury. 

Cord prolapse is not unusual, and the baby must be delivered within less than 10-12 minutes to have a chance of survival. With planned home birth it's impossible to get to the hospital and have a cesarean delivery in less than 30 minutes at best. 

What is an at-home birth?

A home birth delivery takes place at home, or in a residence, rather than in a hospital or a birth center. Planned home birth is a home birth that has been intentionally planned out to have labor and delivery take place at home rather than a hospital or birth center.

What is an out-of-hospital birth?

An out of hospital birth is a birth that happens out of the hospital, in a residence at home, in a 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 the result of quick labor that never made it to the hospital where only family, EMT's or even just a taxi driver are present). So in reality, much less than 1% of births in the U.S. are planned home births. 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 is not trained as a nurse.

Studies show more deaths and poor 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 U.S. there are no guidelines for home birth patients, and there are also increased risks in home birth deliveries.

In a 2017 study, there were two additional risk factors for home birth which included having a pregnancy over 41 weeks and if you are having your first baby. This makes a total of 5 risk factors that significantly increase a baby's risk of being injured or dying at a planned home birth:

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

Safety when delivering a baby

The main priority when delivering a baby is safety, both for the baby and the mother. Interventions such as cesarean sections can be life-saving especially when minutes make a difference between life and death. Cesarean sections are not available in homebirths.  

A little over 100 years ago, 10 in 100 children died before the age of 1 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 U.S. is 1 in 24,000, while the risk of a baby dying from home birth is 24-times of that risk, over 24 in 24,000 home births.
  • 1 in 750 babies dies during home births while 1 in 24,000 are killed by guns and 1 in 57,000 died driving a Cobra car which was recalled for safety concerns. What is more dangerous?

When comparing interventions between hospital and home births, it is important to compare data of uniformly 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 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. 

Read more on homebirth and out-of-hospital births:

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