Like so many controversial parenting topics, discussing home births brings out dynamic opinions. These controversial topics unfortunately often tear us apart from one another. This week, the American Academy of Pediatrics (AAP) issued a policy statement on home births that will hopefully help inform. In general, the policy statement identified data confirming it’s safer to have birth in a hospital, but outlined ways to decrease risks for moms and families, midwives, and doulas that want to partner with moms to have their babies at home, as safely as possible.
- Home births only occur in about 1% of births here in the United States although interest in increasing. Distance from the hospital matters~ if it takes more than 20 minutes to get into a hospital from home, risk of complications including infant mortality are higher. Data shows that home births carry at 2-3 fold higher risk for infant death when compared to hospital births.
- The AAP states home births should only be considered if no maternal health problems, if it’s a term baby (after 37 weeks and before 41 weeks gestation), labor started at home spontaneously or as an outpatient, and it’s a single pregnancy that isn’t breech. Having had a previous C-section makes a home birth a no-no in their mind.
- The AAP recommends having at least 2 people attending the birth with at least one person at the birth who’s sole job is to care for and tend to the baby after the birth. They outline that the baby’s caregiver needs to know how and why to resuscitate a newborn. The team caring for mom and baby need access to consultation with obstetricians and pediatricians and a well-planned way to access the hospital or medical team easily if needed.
- The AAP says, “Every newborn infant deserves health care that adheres to the standards highlighted in this statement.” Care described includes warming the baby and initial transitions, glucose monitoring, infection monitoring, feeding assessment, jaundice checks, vitamin K shot, Hepatitis B shot, eye infection prevention, hearing screen, newborn blood screen, and follow-up care plans.
I believe we each have the right to make health care decisions that are best for our families. We also must have access to un-biased information on safety. Every single health decision we make is a process where we weigh risks against benefits. Home birth versus hospital birth is no exception.
My disclaimers: I had 2 hospital births which required all sorts of intervention and intensive care—2 C-sections, a bedside resuscitation for my newborn, and a short NICU stay for one of my sons. I would never have wanted to have a home birth after my training in pediatrics. That being said, there were aspects of the hospital care that really upset me. I didn’t have a birth plan, per se. I wanted this: a healthy baby and to survive the delivery without complication. I got both, thank goodness, but it wasn’t perfect. The beginning of motherhood was a challenge for me both times around and in part, I’ve always looked back feeling I should have been a stronger mom in the hospital…
For example, after my second son was born, the nurse practitioner told me on day-of-life #2 that they had forgotten to give him vitamin K. I was stunned into silence. When I then asked to see documentation for the rest of the interventions that occurred while I was away from him in the NICU, I noticed he hadn’t yet gotten his Hep B shot. When I advocated for him to get it before discharge, they reflected inconvenience. I had to ask multiple times. Further, when I came up to breastfeed my sweet little boy in the NICU, I got into an argument with the nurse about the pacifier. I asked her not to use it. I remember realizing she didn’t know I was a pediatrician (she shouldn’t have had to). She seemed to tease me during the conversation and used a patronizing tone when she something like, “Why, do you think it will impair breastfeeding?” She explained that to keep the NICU quiet, she would need to use it. I remember crying into my pillow thinking that already on day-of-life #2 I was failing him. It’s amazing how emotional we get when control is taken away.
I still wouldn’t want a home birth. Aside from my emotional responses to the hospital at the time of my sons’ births I also had the privilege to train as a pediatrician. The statement didn’t change my opinion, my experiences have. The 2-3 fold increase risk of death for a newborn is too big for me to recommend the choice. During the time we attended deliveries at the university during residency, we accepted high-risk deliveries that transferred late from home with midwives. I have also cared for babies who have suffered neurologic tragedies in the home birth setting because of delayed resuscitation and in one case, I helped care for a newborn with a delayed diagnosis of congenital heart disease that may have been picked up if a pediatrician was present at the delivery. Like many pediatricians, I am terrified of home births but also lack expertise and education on their safety and ways to mitigate risk. Those scary experiences in residency compounded my views just as much as witnessing the incredible resuscitations I saw and participated in. I’ve also had the fortune of caring for dozens of babies who were born at home and who have done wonderfully. Yet I still like the safety net a hospital provides for a delivery.
That being said, there are many ways to have a baby…
The American Academy of Pediatrics statement really helped begin the education for me on home births. But it’s certainly clear that differing opinions continue.
Incidentally on Twitter when I saw the policy I asked this question while going through the security line at O’Hare airport.
A HUGE conversation ensued including dozens and dozens of responses. Some pediatricians spoke out, some ethicists weighed in, and many parents provided opinions about their experiences and deliveries. It’s meaty. I really encourage you read the entire conversation here on Storify. Please share your thoughts.