There’s almost no human experience more common than childbirth. Babies were being born long before modern medicine got its start but almost all women in the United States turn to doctors and hospitals when it’s time to deliver a baby. They just don’t want to go it alone.

Some people, however, think an act so natural as giving birth can be accomplished safely at home, without medical intervention. After all, it’s been done that way throughout the ages.

Home birth mother and newbornIn many cases, this is true but childbirth can be tricky and there are lives at stake. Emergency situations arise without advance warning and the correct action must be taken immediately or the health of mother and baby are jeopardized.

It’s been just a few days since the Midwives Alliance of North America published the results of a statistical study of 16,924 planned home births occurring in the United States from 2004 to 2009. The alliance defines a planned home birth as one that has a midwife in attendance. The report presents mostly favorable outcomes but many experts still don’t advocate home births, especially for high-risk pregnancies.

High-risk pregnancies are those where multiple babies are expected; that involve medical diagnoses such as preeclampsia, gestational diabetes, and other medical complications that may affect delivery; history of C-section delivery; and when the baby is in the breech position. There are many other reasons why a pregnancy is considered a high risk, including pregnancies involving assisted reproductive technologies (ART).

Unexpected conditions that require medical intervention include fetal distress or failure to progress, maternal exhaustion, more pain than anticipated, and a host of other situations that require immediate medical care, equipment, or medications that can only be found in a hospital or birth center.

Melissa Cheyney, Associate Professor of Medical Anthropology at Oregon State University who is also an author of the study, is concerned that the current medical system in the US isn’t as integrated as it is in other countries where home births are more common. This lack of integration leaves risky gaps between a woman giving birth at home and the nearest hospital delivery room.

A collective opinion piece published in the Journal of Medical Ethics likens home births to driving without a seatbelt — most trips are safe and a seat belt doesn’t eliminate all risks but driving with a seatbelt is a lot safer than driving without one.

Dr. Jeff Chapa says there “are patients that, in no uncertain terms, should be delivered in a hospital.” He expresses concern that the study is observational, derived from data taken from another study, not direct examination of the patients in question. Chapa, who is the Cleveland Clinic’s Director of Maternal Fetal Medicine, cautions that “the bottom line in all of this is you can’t predict who is going to have an issue or a complication.”



Source: Cheyney, Melissa, PhD, CPM,  LDM, et al. “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.” Wiley Online Library / Journal of Midwifery & Women’s Health. John Wiley & Sons, Inc. Jan 30, 2014. Web. Feb 5, 2014.