By Laurie Barclay
May 28, 2001 -- "Having my baby at home was beautiful, inspiring, awesome!" says Jo Anne Lindberg. "I had complete freedom of movement and absolute choice in everything I wanted to do."
As president and founder of Birthlink in Chicago, a free referral service for expectant parents considering home birth, Lindberg often refers women to Penny Shelton, MD, MPH, a general practitioner with HomeFirst, a group that has safely delivered more than 15,000 babies at home.
"Giving birth at home supports the normal physiology better," Shelton tells WebMD. "We're treating it as a normal part of life instead of a medical condition." Studies have shown that women who feel anxious or stressed release more adrenaline, a hormone that interferes with labor, she explains.
Not for Everyone
But home birth is not for everyone. Shelton says that women with uncontrolled diabetes, chronic high blood pressure, or a condition called toxemia (also known as preeclampsia) should deliver in the hospital. If labor begins before 37 weeks in a woman who's already given birth, or before 38 weeks in a first-time mom, it's safer to go to the hospital.
And if the father does not fully support the mother's decision to give birth at home, Shelton also recommends against it.
In the absence of these complications, home birth is typically safe, provided there are enough trained hands on board. Shelton prefers to work with a team that includes a midwife and nurse, but acknowledges that some well-trained certified midwives are capable of delivering without the assistance of a physician.
"Most physicians and nurse midwives are unwilling to attend home births," Martin A. Monto, PhD, chair of social and behavioral sciences at the University of Portland in Oregon, tells WebMD. He explains that most home births are attended by "direct entry" or "lay" midwives who learn through apprenticeship rather than through conventional medical training.
Their training may include skills not traditionally taught at medical or nursing school, such as gentle stretching of the tissues surrounding the birth canal to avoid having to surgically cut the tissue to allow the baby's head to pass through, a procedure called an episiotomy. Direct entry midwifery is illegal in some states, he says.
Home Birth Less 'Medical' for Most
"When comparing women with low-risk pregnancies, women who give birth at home are less likely to have episiotomies, C-sections, and all other forms of medical intervention than women giving birth in hospitals," Monto says.
Shelton carries emergency equipment, including oxygen for babies not breathing well, but seldom has to use it.
Alice Bailes has the same experience.
"I throw out my IV bags because they're expired more often than I use them," says Bailes, CMW, co-director of BirthCare and Women's Health, a service of certified nurse-midwives in Alexandria, Va. Her delivery team often includes an RN or practitioner certified in neonatal advanced life support.
To make labor more comfortable and efficient, Bailes recommends "low-tech" interventions like changing position or taking a shower. Being able to move around free of a fetal monitor, IV, and other restraints typically used in a hospital is also a major advantage, she explains, as is not being pressured to deliver within a specified timeframe.
But Going to the Hospital Is Not 'Failure'
Despite these advantages, Bailes says that about 25% of first-time moms and about 4% of those who have already had children have to be transferred to a hospital for delivery. This happens mostly because of failure to progress, meaning that the woman becomes exhausted and feels that she can't deliver the baby on her own.
It's important not to refuse hospital help at this stage, says Ole Olsen, MSc, associate director of the Nordic Cochrane Centre in Copenhagen, Denmark. The Cochrane Centre has analyzed medical studies from around the world, including a study showing that if the mother refuses medical help despite problems with labor, home birth resulted in an increased death rate for both mothers and babies.
"If at any time you feel you need to abandon the home birth, trust yourself, and don't let someone else talk you out of it," says Hilda Bastian, a consumer advocate for home birth at the Flinders University of South Australia. "Going to the hospital is not failure -- if you think you or your baby need it, it's just being responsible."
"As long as the woman is followed by an experienced home birth practitioner who will transfer for hospital birth in case of any problems, home birth is not dangerous," Olsen says. He refers to two reviews showing that the infant death rate for planned home birth is very low and similar to that for planned hospital birth, provided the mother is healthy and the pregnancy is normal.
Low-risk pregnancies had infant death rates of 2.0 per 1,000 for home birth and 2.2 per 1,000 for hospital birth, says David Anderson, PhD, associate professor of economics at Centre College in Danville, Ky. Only 3% of low-risk mothers intending to deliver at home end up with C-sections, compared with 8-27% of low-risk mothers delivering in the hospital.
All experts interviewed stressed the importance of regular prenatal care in recognizing and preventing potential problems, and of having physician backup for in-hospital delivery in case something goes wrong. Arranging for a pediatrician to see the newborn within 24 hours is also essential, Bailes says.
Other Benefits: Less Costly, Fewer Germs, More Bonding
"The average uncomplicated vaginal birth costs 68% less in a home than in a hospital," Anderson tells WebMD. Home birth is seldom covered by insurance, Monto says, but Lindberg points out that paying out-of-pocket for home birth may be less expensive than purchasing a pregnancy rider. HomeFirst charges $750 for physician-attended home delivery.
But the real benefits of home birth can't be measured in dollars or in statistics, these experts agree. Mother-child bonding, parenting, breast-feeding, and infant health may all be enhanced by the home birth experience.
"It's a family-centered event -- those first early hours are so precious," Lindberg says. "You're bringing a baby into a home full of love rather than a hospital full of germs."
Mothers and babies may be exposed to more types of disease-carrying organisms in the hospital environment, particularly in the nursery where all newborns are clustered together. While the home environment is hardly sterile, at least the mother has been exposed to the same organisms before and may have built up immunity against them.
By keeping mother and child together immediately after birth, home birth promotes bonding and breast-feeding, Shelton says. At HomeFirst, 100% of babies were still breast-feeding at 6 months and 1 year. Advantages of early breast-feeding include helping the mother to stop bleeding, clearing mucus from the baby's nose and mouth, and transferring disease-fighting antibodies in the milk from mother to baby.
After home birth, the mother has "a strong feeling that she can manage whatever joys and hardships she will meet when caring for the new small baby," Olsen says.
And if her husband takes part, he "will see, hear and experience with all his senses that he is married to the strongest and most wonderful woman he could imagine," he says. "Not a bad start for a new family!"
Laurie Barclay, MD, is a neurologist in private practice in Tampa, Fla. She's been widely published in both peer-reviewed scientific journals and medical textbooks.
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