Who is homebirth safe for?
Photo by Alexis Beatty
Homebirth is considered to be a safe and appropriate option for people having low-risk pregnancies. But how do you know if you are low risk, and what else should be taken into consideration?
“Low risk” generally means coming into pregnancy without diabetes, hypertension, blood clotting issues, lupus, cancer, or any other conditions or diseases that create more risk for mother/parent and baby during pregnancy and birth. Some conditions can develop during pregnancy that could move someone from low to high risk, like gestational diabetes that requires medication to regulate, preeclampsia, or intrauterine growth restriction. This is not an exhaustive list of potential complications.
The good news is that most pregnancies are low risk. Even if you are, for example, considered “advanced maternal age,”or have a higher BMI (though BMI is a faulty judgement of health), if there are no conditions you live with that raise risk, you are likely still a good candidate for homebirth. I recommend speaking to homebirth midwives in your area, share your situation and health history, and have a conversation about risks and benefits and whether they attend births like yours. Whenever I speak on the phone to a potential client, this is one of the first things we discuss to make sure we’re a good fit for before turning our attention to other factors that could go into their decision about their care.
The truth is while some things are fairly black and white, “safety” can be subjective as well as relative in pregnancy and birth, and no matter where you have your baby, there is inherent risk. There are quality studies demonstrating safety of the midwifery model of care in the home, showing less overall interventions used, without increased adverse events and outcomes for babies and mothers/parents. They also have shown high quality prenatal care and postpartum care by midwives in addition to their birth attendance. The overall cesarean rate for homebirth families is 5% as opposed to 33% of families who birth in US hospitals. If you’d like to learn about this in more detail, a good place to start is: Outcomes of care for 16,924 planned homebirths in the United States.
Besides whether or not you are experiencing a low risk pregnancy, consider how far away you are from a hospital with an obstetric unit should something develop in labor that requires transfer. If you live in a maternity care desert, you may be someone who is actually relying on community midwifery to help you access perinatal care where it is scarce. If you live in Nashville, TN or immediately surrounding areas, there are several hospitals close by with capacity to care for families transferring from home. You should also consider how the midwives in your area practice: do they work with assistants during birth? Do they have a backup midwife? Do they carry emergency medications for hemorrhage? Are they certified in Neonatal Resuscitation, and do they carry the necessary tools? Do they have the skills and tools to suture tears at home? Have they ever missed a birth, and why?
The last thing I’ll speak on but the first thing to always consider is where YOU feel safest. Even the best of midwives will not be able to be very helpful to you if you don’t feel safe in the environment. Is your home the place where you feel safest to be in the vulnerable, powerful, intimate space that is labor and birth? If not, think about why that might be. Do you feel safer in a loved one’s home, or a birth center? Or does something tell you that you need to be in the hospital? Being a licensed homebirth midwife, I am of course partial to attending births in the home setting, and in Tennessee the home and the birth center are where my license permits me to practice. That doesn’t mean I think everyone should have a homebirth, however. You get to make that choice, and hopefully you live somewhere where choices abound. In Nashville and areas within an hour radius that I serve, I can happily report that there are several models of care available for families to choose from, and many midwifery and obstetric practices.
