Home births or hospital? The debate goes on

Published: Aug. 5, 2019 at 3:52 PM EDT
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The birth of a new baby is a joy like no other.

Usually, it all unfolds in a hospital's maternity department. But a growing number of women are going back to basics and staying at home.

While women like the trend, doctors do not.

Sarah Rankin's family is about to get a little bigger. And just like first child, Charlotte, Rankin's family wants the baby to come into the world right in their home.

"You're able to control the vibe of your birth," Rankin said. "So, she was born in a dark room with silence, instead of beeping and screaming and people rushing around. It was just so serene."

But it's still rare. Less than 1% of the 4 million births in the U.S. last year happened at home.

Dr. Jill Hechtman says it's because it's too risky. One study found 23% to 37% of women who tried to give birth at home wound up being rushed to the hospital.

"I'm not a big proponent of home birth, because I've seen the bad things that can happen, and I know there's only minutes when they do happen," Hechtman said.

Hechtman says the mortality rate for home-birth babies is roughly twice as high as hospital births: thirteen fatalities versus six for every 10,000 in a hospital.

"We are licensed and regulated by the state," midwife Charlie Rae Young said.

Young says safety contingencies are in place if there's a complication.

"It's not home birth at all costs," she said.

But Hechtman still is not convinced.

"I would rather embrace the patients that would consider home births and talk to them and provide them what they want in a hospital setting," Hechtman said.

But for Rankin, there is no doubt about where she will welcome baby No. 2.

Doctors and midwives do agree on one thing, and that is that some women are better candidates for home deliveries than others. For example, those without any previous health problems or caesarean sections and usually women only having one baby and not twins or triplets.

Montana, Vermont and Wyoming are among the top states for home births, and some counties in Florida are among the highest in the nation with 7% of women choosing home birth compared to the national average of only 1%.


REPORT #2664

BACKGROUND: A planned home birth means you give birth at home instead of a hospital or birthing center. You still need the assistance of someone experienced and qualified during labor and delivery such as a certified nurse midwife, a certified midwife, a midwife whose education and licensure meets international standards, or a doctor who practices obstetrics. Planned home births are associated with double to triple the risk of infant death or severe injury than births at hospitals. The percentage of U.S. births that occurred at home increased by 29 percent, from 0.56 percent of births in 2004 to 0.72 percent in 2009. About one in every 90 births for non-Hispanic white women is now a home birth. Home births are more common among women aged 35 and over and among women with several previous children. Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer pre-term, low birthweight, and multiple births. (Source: https://www.healthline.com/health/pregnancy/home-birth-vs-hospital-birth and https://www.cdc.gov/nchs/products/databriefs/db84.htm)

HOME BIRTH SAFETY: Women who have had a prior C-section, or who are pregnant with multiples (twins, triplets) should not have a home birth. Even with a planned home birth, your doctor or midwife may recommend that you be moved to a hospital after labor begins. Some complications may arise such as high blood pressure, you ask for pain relief, your baby is not positioned correctly, or you have vaginal bleeding. Other complications can be your baby showing signs of distress before delivery (abnormal heart rate), or after birth (signs of a medical condition or difficulty breathing), if your labor isn't progressing, traces of meconium are found in your amniotic fluid, you experience complications like placental abruption (when the placenta detaches from the lining of the uterus before delivery), or umbilical cord prolapse (when the umbilical cord drops into your vagina before your baby), or the placenta isn't delivered, or isn't delivered completely. (Source: https://www.healthline.com/health/pregnancy/home-birth-vs-hospital-birth#safety)

A GREATER ROLE FOR MIDWIVES: States that give midwives a greater role in patient care achieve better results in maternal and neonatal health. In Great Britain, midwives deliver half of all babies. In Sweden, Norway and France, midwives oversee most expectant and new mothers, enabling obstetricians to concentrate on high-risk births. In Canada and New Zealand, midwives are highly valued and brought in to manage complex cases that need special attention. All of these countries have much lower rates of maternal and infant mortality than the U.S. In the U.S., severe maternal complications have more than doubled in the past 20 years. Now a groundbreaking study, the first systematic look at what midwives can and can't do in the states where they practice, offers new evidence that empowering them could significantly boost maternal and infant health. The five-year effort by researchers in Canada and the U.S., found that states that have done the most to integrate midwives into their health care systems, including Washington, New Mexico and Oregon, have some of the best outcomes for mothers and babies. "We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes," said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia. (Source: https://www.propublica.org/article/midwives-study-maternal-neonatal-care)