Home birth: Who shouldn't consider it?

My wife is pregnant with our second child. She is interested in exploring the option of home birth, but this makes me very nervous because she had problems with high blood pressure in her first pregnancy. What do you think?

- Manuel / Texas

Mayo Clinic obstetrician and gynecologist Roger Harms, M.D., and colleagues answer select questions from readers.

Answer

I agree with you. The idea of home birth makes me very nervous, too.

A planned home birth assisted by a trained midwife may result in a normal delivery and healthy child. But unexpected problems can and do arise that threaten the life of the mother or child. In addition, certain medical conditions during pregnancy can increase the risk of serious complications during childbirth, including:

Diabetes
Chronic or gestational high blood pressure
Any chronic condition that requires medication
Preeclampsia
Any bleeding during pregnancy
Preterm labor
A history of postpartum bleeding
Prior C-section
First labor after age 35
Fetal growth abnormalities

Since your wife had high blood pressure during her first pregnancy (gestational high blood pressure), she is probably not a good candidate for home birth. High blood pressure during pregnancy increases the risk of serious complications, such as preterm labor and placental abruption.

In October 2006, the American College of Obstetricians and Gynecologists issued a statement saying a hospital or a birthing center within a hospital is the safest setting for labor, delivery and immediate postpartum monitoring.