The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.
The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth. It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so.
Home births have long been debated amid concerns about their safety. But a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.
As always, it is important to look closely at details of the Dutch study. Yes, home birth can be as safe as hospital birth. IF risk factors like multiples, breech, previous c/s are screened out. AND there is early transport with any hint of trouble--1/3 of home birth attempts in this study. Early transport is key to good outcomes. Of course, the Dutch are progressive enough that their midwives can follow them into the hospital to continue to provide seamless care if all they need is a little pit, or epidural.
In my state, LICENSED direct midwives are able to deliver twins, VBAC, and breech at home. We have found disturbing documentation of losses within LDM practice related specifically to these risk factors. Those standards of practice have to change to establish safety for those opting home birth.
Ultimately, mandatory licensure, consistent standards of practice would benefit both DEMs and birthing families by making home birth possible to more.
Ironic someone posted this topic--not sure if any of you have seen this show, but Discovery Health has a new series/documentary (not sure which one) called 'Freebirthing'. It followed 3 women from the US and UK that have decided to birth at home without ANY medical intervention--MD or midwife. Scary to me, but to each their own I guess.
My biggest fear about "freebirthing" is that HMOs will make it the standard of care for pregnancy. Imagine how much money that would save.
My biggest fear about "freebirthing" is that HMOs will make it the standard of care for pregnancy. Imagine how much money that would save.
Seriously? I haven't seen the show but I don't see any time before H*ll freezes over that ACOG, Big Insurance, and the attorneys that serve them advocating home births, much less do-it-yourself because it's cheaper.
My biggest fear about "freebirthing" is that HMOs will make it the standard of care for pregnancy. Imagine how much money that would save.
Not likely. I think the larger hurdle will be fixing the high rate of social inductions, unnecessary interventions, and unneeded c-sections that are costing us all money and contributing to the failure of our health system. I find it highly unlikely that insurance companies would swing from not covering evidence-supported, money-saving homebirths to requiring unassisted childbirth.
I thought "Freebirthers" were women who refused all medical care during pregnancy, including prenatal care, not just women who give birth at home, without drugs. That's why I would be afraid of HMOs adopting it: it would create more barriers for women who need prenatal care.
Home birth is fine if you're low-risk, but how do you know you're low-risk without prenatal care?
I thought "Freebirthers" were women who refused all medical care during pregnancy, including prenatal care, not just women who give birth at home, without drugs.
Yes. In theory this is plan of a 'freebirther'.
That's why I would be afraid of HMOs adopting it: it would create more barriers for women who need prenatal care.
Honestly you can safely put that fear to rest. There is no way after a hundred year campaign to take birth out of the home and medicalize it to the highest degree that DOCTORS would allow that to happen. If HMOs did something like that, you'd better believe that ACOG would suddenly be in the insurance business
I thought "Freebirthers" were women who refused all medical care during pregnancy, including prenatal care, not just women who give birth at home, without drugs. That's why I would be afraid of HMOs adopting it: it would create more barriers for women who need prenatal care.
Home birth is fine if you're low-risk, but how do you know you're low-risk without prenatal care?
Yes, that's what freebirthing is. Many women who do this do this monitor themselves very carefuly. They check their blood pressure, blood sugar, weight, fetal heart tones, etc. They often keep careful records as well. Same as would happen in prenatal care. They lack the professional expertise, but let's face it many women barely even get to talk to their OB provider, let alone know them well enough for them to recognize a subtle problem.
I work in the UK as a midwife where home births are very common. Luckily we don't have the problem of obstetricians wanting to make their money due to the NHS.
I am lucky enough to have attended many wonderful homebirths and highly recommend them.
For the low risk pregnancy I think it would be OK. Personally for me I want everything available in case my low risk suddenly becomes high risk. The parents have to be willing to take that chance that the woman will die and the baby will die. Not that it doesn't happen in the hospital as well but advanced lifesaving equipment is more readily available. For quicker intervention. I think people have to know the risks just like when patients have to sign a VBAC consent I think they should sign a homebirth consent. Now I do belive there is a difference between a planned delivery at home and a 4 year old calling 911 because the "baby's head is comming out"
I think people have to know the risks just like when patients have to sign a VBAC consent I think they should sign a homebirth consent.
In the two states I have practiced in it is mandated parents sign an informed consent to midwifery care and to have a home birth when you hire the midwife. You don't have to sign a consent to a hospital birth until you're triaged in the unit in labor. Interesting, huh?
For the low risk pregnancy I think it would be OK. Personally for me I want everything available in case my low risk suddenly becomes high risk. The parents have to be willing to take that chance that the woman will die and the baby will die. Not that it doesn't happen in the hospital as well but advanced lifesaving equipment is more readily available. For quicker intervention. I think people have to know the risks just like when patients have to sign a VBAC consent I think they should sign a homebirth consent. Now I do belive there is a difference between a planned delivery at home and a 4 year old calling 911 because the "baby's head is comming out"
But the fact is there is no increased risk associated with home birth so there is no need for that extra consent.
True that there may be moms or babies lost in homebirth that wouldn't be lost in the hospital but there are moms lost in the hospital that would not be lost in homebirth. It evens out in the end. Unless we start having moms going to the hospital sign a form saying they understand that they are of increased risk of infection, perineal injury, surgery, DVT, DIC, medication use, and hemorrhage then a homebirth "informed consent" wouldn't really be a fair requirement.
Here's one to the contrary - the studies seem to go back and forth. I love the debates & would love to see this study torn apart with all the ins & outs...
Midwife-Attended Home Births Less Safe Than In-Hospital Deliveries
mamafeliz
56 Posts
As always, it is important to look closely at details of the Dutch study. Yes, home birth can be as safe as hospital birth. IF risk factors like multiples, breech, previous c/s are screened out. AND there is early transport with any hint of trouble--1/3 of home birth attempts in this study. Early transport is key to good outcomes. Of course, the Dutch are progressive enough that their midwives can follow them into the hospital to continue to provide seamless care if all they need is a little pit, or epidural.
In my state, LICENSED direct midwives are able to deliver twins, VBAC, and breech at home. We have found disturbing documentation of losses within LDM practice related specifically to these risk factors. Those standards of practice have to change to establish safety for those opting home birth.
Ultimately, mandatory licensure, consistent standards of practice would benefit both DEMs and birthing families by making home birth possible to more.