Safety of Homebirth
"Is it safe?" - this is one of the most common questions people ask about home birth.
The answer: If you are a healthy woman working with a qualified prenatal and birth attendant, you and your baby are equally safe to birth in hospital, birth center, and at home. Research findings favor the out-of-hospital setting for decreased interventions and increased satisfaction. "Decreased interventions" means significantly more out-of-hospital women heal faster and enjoy greater breastfeeding success and postpartum well-being than low-risk women who birth in a hospital. (Scroll down the page for research excerpts and links to full texts.)
We encourage you to individualize your pregnancy and birth choices to satisfy your deepest instincts and desires.
Midwives help make birth safe by prioritizing prevention, partnership and continuity. Midwives engage you in thorough self and baby assessments and important nutritional, stress reduction, and physical activity measures. Midwives invite honest and open communication toward an individualized commitment to health and prompt detection of problems should any arise. At Community Midwives, the same midwife who attends you in pregnancy will be at your side in birth and through the first tender days postpartum.
A qualified midwife carries first-line response equipment and treatments similar to those found at level-one hospitals. These include IV equipment and fluids, anti-hemorrhagic medications, oxygen for mother and baby, a bag and mask to deliver oxygen, doppler ultrasound to assess fetal heart tones, and an established system of medical collaboration and transfer. Qualified midwives and their assistants are regularly recertified in neonatal resuscitation and CPR.
Community Midwives has helped train many area EMTs and paramedics in home-to-hospital transfer (read more here) and works continuously to educate public and health care colleagues regarding midwives and homebirth and to optimize collaboration within the health care system. Due to the potential that always exists for transfer to medical care, most women choose to visit a physician or hospital nurse-midwife in pregnancy and pre-register at their nearest hospital. This allows staff to initiate measures prior to arrival and make your welcome there more efficient and comfortable.
Four urgent transfers have occurred at Community Midwives in eight years of practice. The great majority of problems that can arise in healthy mothers and newborns respond rapidly to first-line measures at home. In the rare event of transfer - about 7% overall - we feel grateful for our strong bridges to hospital-based medical professionals and excellent services they provide.
RESEARCH AND POLICY
The American Public Health Association, the Royal College of Obstetricians and Gynecologists, the World Health Organization, The Cochrane Collaboration, and numerous evidence-based health care systems endorse homebirth with a qualified midwife as a safe and an effective option with long-term health and social advantages. See excerpts from official health policy statements below.
MIDWIVES
“The midwife appears to be the most appropriate and cost effective type of health care provider to be assigned to the care of normal pregnancy and normal birth, including risk assessment and the recognition of complications. [The recommendations accepted by the General Assembly of the XIII World Congress of FIGO (International Federation of Gynaecology and Obstetrics) in Singapore 1991] point to the midwife as the basic health care provider in obstetrics.” Care in Normal Birth: A practical guide. World Health Organization, 1997. (See the WHO document here)
PLANNED HOME BIRTH
“There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families..... Overall, the literature shows that women have less pain at home and use less pharmacological pain relief, have lower levels of intervention, more autonomy and increased satisfaction. The studied interventions included induction, augmentation, perineal trauma and episiotomy,instrumental delivery and caesarean section. These are not insignificant interventions and may have considerable impact on a woman’s long-term health and emergent relationship with her baby, as well as her satisfaction with her birth experience.” The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG), April 2007 (view the full text here)
"We are committed to offering all women the choice of how and where to give birth." Department of Health, National Health Service, United Kingdom, 2006.
"Recognizing the evidence that births to healthy mothers, who are not considered at medical risk after comprehensive screening by trained professionals, can occur safely in various settings, including out-of-hospital birth centers and homes...APHA supports efforts to increase access to out-of-hospital maternity care services.” American Public Health Association, “Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002.
“...a woman should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible and safe. For a low-risk pregnant woman this can be at home, at a small maternity clinic or birth centre, in town or perhaps at the maternity unit of a larger hospital. However, it must be a place where all the attention and care are focused on her needs and safety, as close to home and her own culture as possible."Care in Normal Birth: A practical guide. World Health Organization, 1997.(See the WHO document here)
THE COCHRANE COLLABORATION OF SYSTEMATIC REVIEWS
"All women should be offered midwife-led models of care and women should be encouraged to ask for this option." Midwife-led Versus Other Models of Care for Childbearing Women (review summary of 11 trials in 4 countries including 12,276 women), The Cochrane Collaboration, 2009 (view the full text here)
“Several methodologically sound observational studies have compared the outcomes of planned home-births (irrespective of the eventual place of birth) with planned hospital-births for women with similar characteristics. A meta-analysis of these studies showed no maternal mortality, and no statistically significant differences in perinatal mortality risk in either direction.” Murray Enkin, et al, A Guide to Effective Care in Pregnancy and Childbirth. Oxford University Press, 2000.
“It is inherently unwise, and perhaps unsafe, for women with normal pregnancies to be cared for by an obstetric specialist. ... Midwives and general practitioners, on the other hand, are primarily oriented to the care of women with normal pregnancies, and are likely to have more detailed knowledge of individual women.” Murray Enkin, et al, A Guide to Effective Care in Pregnancy and Childbirth. Oxford University Press, 2000.