Labor and delivery, postpartum care

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continued:

Home birth: Know the pros and cons

What might cause the need for a hospital transfer?

During a planned home birth, you might need to be transported to a hospital for monitoring or treatment. Your health care provider might recommend transfer to a hospital if:

  • Labor isn't progressing
  • Traces of fecal waste (meconium) appear in your amniotic fluid
  • The placenta peels away from the inner wall of your uterus before delivery (placental abruption)
  • The umbilical cord drops into your vagina ahead of the baby (umbilical cord prolapse)
  • You have vaginal bleeding not associated with bloody show — a thick plug of mucus that blocks the cervical opening and falls out when the cervix thins and opens
  • You don't deliver the placenta or it's not delivered intact
  • Your baby shows signs of distress, such as an abnormal heart rate

What are the possible risks of a planned home birth?

While most pregnant women who choose to have planned home births are at lower risk of complications due to careful screening, planned home births are associated with double to triple the risk of infant death than are planned hospital births. Still, even with that increase, the overall risk of infant death is low.

How do I prepare for a home birth?

You can prepare for a planned home birth by:

  • Choosing a trained health care provider to assist. Choose a certified nurse-midwife, a certified midwife or a doctor who has a formal relationship with a health care system overseen by your state health department or the Joint Commission. Make sure he or she has easy access to consultation with doctors or specialists at a collaborating hospital, if necessary. If you're interested in additional physical and emotional support, consider hiring a doula — a professional labor assistant.
  • Creating a birth plan. Where do you plan to experience labor and delivery? Will you use any specific methods, such as Lamaze, to cope with pain? Do you plan to have a water birth? Will you breast-feed your baby immediately after delivery? What other family members or support people will be present? Be sure to discuss the details of your birthing plan with your health care provider. Ask your health care provider what kind of supplies you'll need to provide, such as towels, sheets or other protective coverings for your floor or mattress.
  • Preparing for a hospital transfer. Discuss with your health care provider the signs and symptoms that might necessitate going to a hospital and how a hospital transfer will affect your birthing plan. Ideally, your home or other planned birth location is within 15 minutes of a hospital with 24-hour maternity care. Make sure you have access to transportation. Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly transferred and treated, if necessary.
  • Choosing a pediatrician. Plan a medical exam for your baby within a few days of birth.
  • Arranging for postpartum help. After delivery, you might need help caring for yourself and your new baby. Arrange for family or friends to help. A doula can also provide postpartum support.

What else do I need to know about a planned home birth?

With careful planning, a home birth can be a positive and rewarding experience. Keep in mind, however, that life-threatening problems can occur during labor and delivery without warning. In those cases, the need to transfer you and your baby to a hospital could delay care, which could put your lives at risk. Understanding the risks and benefits of a home birth can help you make an informed decision about how you plan to give birth.

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References
  1. Malloy MH. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004. Journal of Perinatology. 2010;30:622.
  2. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Planned home birth. Committee opinion No. 476. Obstetrics & Gynecology. 2011;117:425.
  3. Wax JR, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: A metaanalysis. American Journal of Obstetrics and Gynecology. 2010;203:243.e1.
  4. Janssen PA, et al. The experience of planned home birth: Views of the first 500 women. Birth. 2009;36:297.
  5. Declerq E, et al. Planned home birth. http://www.uptodate.com/home/index.html. Accessed March 16, 2011.
  6. Where women give birth. American College of Nurse-Midwives. http://www.mymidwife.org/index.asp?bid=130. Accessed March 23, 2011.
  7. Boucher D, et al. Staying home to give birth: Why women in the United States choose home birth. 2009;54:119.
  8. Davis-Floyd R. Home birth emergencies in the U.S. and Mexico: The trouble with transport. Social Science and Medicine. 2003;56:1911.
  9. Is home birth right for you? American College of Nurse-Midwives. http://www.mymidwife.org/index.asp?bid=162. Accessed March 25, 2011.
  10. Your Pregnancy and Childbirth: Month to Month. 5th ed. Washington, D.C.: American College of Obstetricians and Gynecologists; 2010:124.
  11. Stuebe A, et al. Continuous intrapartum support. http://www.uptodate.com/home/index.html. Accessed March 25, 2011.
  12. Shelov SP, et al. Caring for Your Baby and Young Child: Birth to Age 5. 5th ed. New York, N.Y.: Bantam Books; 2010: 47.
  13. Lothian JA. Preparation for labor and childbirth. http://www.uptodate.com/home/index.html. Accessed June 3, 2011.
  14. Johnson KC, et al. Outcomes of planned home births with certified professional midwives: Large prospective study in North America. British Medical Journal. 2005;330:1.
  15. Newborn screening. http://www.cdc.gov/ncbddd/pediatricgenetics/newborn_screening.html. Centers for Disease Control and Prevention. Accessed June 7, 2011.
MY01713 June 21, 2011

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