New Recommendations Say That Safe Home Birth Is Safer For Women

hospital baby
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It's one thing for women to discuss the merits of giving birth at home vs. giving birth in the hospital, but it's quite another for a Harvard obstetrician to openly discuss the topic.  

I've hard mothers debate the merits of giving birth at home, while others swear that they would never give birth anywhere other than a hospital. As a labor and delivery nurse, I see both sides of the discussion: on one hand, things can go horribly wrong very quickly even in healthy, normal pregnancies and births but on the other, sometimes hospitals really do cause more complications for both mothers and babies.

 

It's a tough question to answer and like most things when it comes to American motherhood, we usually just leave moms to muddle their way through without a whole lot of clear-cut information. But that may be about to change, as a Harvard Obstetrician has recently spoken out on the safety of giving birth at home. 

Dr. Neel Shah recently wrote an article in which he discussed the surprising opinion that, even from a doctor's point of view, home birth just may be the safer option for women. One of the main reasons? Home birth leads to less interventions, which leads to less C-sections, a potentially dangerous surgery for both mom and baby and one that is costing us billions in healthcare costs. "Many of the patients I care for benefit from my surgical training. I get to save lives while also sharing in one of the most profoundly joyous moments that families experience. But obstetricians like me may be hardwired to operate, and too many operations are harmful to patients," explained Dr. Shah.

"One strategy to fix this might be to change our wiring. Another may be the British way: for patients to stay away from obstetricians altogether – at least until you need one."

The doctor spoke out after surprising recommendations from the National Center that actually (surprise!) supported a woman's right to give birth at home.

The recommendations include:

  • Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth."
  • Advise low‑risk nulliparous women that planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Explain that if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby.
  • Planning birth at home or in a freestanding midwifery unit is associated with a higher rate of spontaneous vaginal birth than planning birth in an alongside midwifery unit, and these 3 settings are associated with higher rates of spontaneous vaginal birth than planning birth in an obstetric unit 
  • Planning birth in an obstetric unit is associated with a higher rate of interventions, such as instrumental vaginal birth, caesarean section and episiotomy, compared with planning birth in other settings
  • There are no differences in outcomes for the baby associated with planning birth in any setting

What does all of this mean? In other words, according to the NICE, giving birth at home is safe and is actually the preferred setting for healthy, low-risk women. 

Say.what?

This goes against everything that most us of here in our Western medicalized world have been taught to know about pregnancy and yet, it makes a lot of sense. Pregnancy and birth are natural processes and while that doesn't mean that emergencies don't happen, birth is best approached with support and help available at home for low-risk women. We wouldn't expect that every person with a common cold would need to see a neurosurgeon, right?

Perhaps the right way to approach pregnancy and birth is in matching women more appropriately based on their needs during pregnancy, sorting care in a more cost-effective manner (for instance, midwives are a lot more affordable than obstetricians), and looking at the evidence to change up our own way of practicing maternity care. 

We also need to understand that the United Kingdom offers a completely different system for women during pregnancy, labor, and postpartum, offering home visits after the baby is born, midwife-centered care, and a lot more at-home services that make their whole philosophy much safer and supportive for women. So you can't exactly apply the same statistics here in the United States, where women receive different care before, during, and after pregnancy. 

Even though I have to admit that the thought of having a home birth makes me nervous (and I know it would make my husband nervous), I am open to knowing the real facts about the safety of home birth for moms and babies. 

Would you consider a home birth based on this new evidence? 

Sources:

National Institute for Health Care and Excellence. Intrapartum care: care of healthy women and their babies during childbirth. Accessed June 7, 2015: http://www.nice.org.uk/guidance/cg190/chapter/1-recommendations 

Time. Harvard Obstetrician Speaks on Safety of Giving Birth At Hospitals. Accessed June 7, 2015: http://time.com/author/the-conversation/. 

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