Having a Baby?
|Why Do Women Consider Home Births?
Every year in America about 50,000 women choose to have their babies at home (image). Although this only accounts for 1 percent of all births, the figure is on the increase. One of the main reasons for the rising popularity of home births (particularly waterbirths), is a woman's desire to avoid over-medicalized hospital births. C-section deliveries are at an all time high of more than 31 percent of all deliveries in hospitals and this figure has risen 50 percent over the past decade. Home births in comparison require far fewer interventions with less than 4 percent of women transferring for a C-section delivery. Women are also choosing to have home births because they want to attempt a natural vaginal birth after a previous cesarean (VBAC). Most hospitals and obstetricians refuse to carry out a VBAC in case of potential lawsuits. However, the American College of Obstetricians and Gynecologists (ACOG) continues to reiterate its long-standing opposition to home births on the basis that complications can arise even in women with low-risk pregnancies. They insist that deliveries should be made either in a hospital or at accredited birthing centers.
A home birth is usually carried out by a midwife. Much of the controversy in recent years in America has been about the accreditation of some midwives to perform the service. A midwife assisted home birth is not always easy to arrange legally. Twenty seven states allow direct entry midwives (also called Certified Professional Midwives, CPMs) to attend home births. CPMs are trained to national standards for home births. However in the remaining states, licensing laws are lacking, and CPMs cannot deliver home births without a nursing qualification. In fact, a midwife needs to be certified as a nurse midwife (or CNM) to legally assist in a home birth. The difficulty here is that most CNMs choose not to deliver at home, preferring to offer delivery and childbirth services in hospitals or birthing centers instead.
Mothers Naturally is a public education program from the Midwives Alliance of North America. Their site may help you locate a certified midwife in your area: www.mothersnaturally.org
Most women build a rapport and relationship with their midwife during their prenatal visits. This is usually a friendlier environment than visiting an OB/GYNs office or public health department. You will be provided with a prenatal care guide, discuss nutrition, exercise and what to expect during labor - including possible options like a waterbirth and hiring/buying a birthing pool. When the big day arrives and labor starts, your midwife will arrive with all the necessary tools for facilitating a safe birth. A typical kit (some of which is only in case of emergency) includes an IV support, oxygen for the baby, sterile gloves, waterproof covers for the bed, a doppler, a fetoscope, and drugs to prevent or stop hemorrhages. Depending on the midwife, they may also bring homeopathic remedies, oils and even acupuncture needles. They will also have tools for suturing tears. Once the baby has been delivered, your midwife will recommend a pediatrician to see the baby within 24 hours. It is worth restating that an epidural pain relief is not an option for births at home.
What Happens To The Placenta?
Usually the midwife will take the placenta with her for disposal. Occasionally the parents wish to keep it for their own reasons. Planting the placenta in the garden as a way of honoring the birth of the child is becoming more popular for example.
Who Can We Have At The Birth?
This is between the woman, her family and the midwife. Most midwives do not have a specified number of people they allow into the birthing room, but you do need keep in mind practical safety precautions. It is not sensible to fill up the room so you cannot move around.
The Argument: FOR
Studies indicate that home births have the same (or less) rate of death, infections or injuries as hospital births. A 6 year study by the Texas Department of Health, published in 1990 showed that infant mortality rate was 1.9 per 1,000 for non-nurse midwife attended births. In Certified Nurse Midwife births, this was 1 per 1,000 and for a doctor delivery it was 5.7 per 1,000. A study published by the BMJ (British Medical Journal) in 2005 found that the neonatal death rate was comparable in home and hospital deliveries.
Reduced Costs: A typical uncomplicated vaginal birth at home costs about 60 percent less than in a hospital. This is particularly relevant to women with limited or no medical insurance. See prenatal care costs.
The Argument: AGAINST
The American College of Obstetricians and Gynecologists (ACOG) insists women should not be unduly influenced by 'fashion' when it comes to childbirth methods. They state that a normal healthy pregnancy can suddenly develop complications which may need instant hospital care. Also, they warn against attempting a vaginal birth after cesarean (VBAC) at home, as risking a uterus rupture is particularly dangerous.
ACOG recognizes that C-Sections rates are much higher in hospitals and are committed to reducing these rates. They insist however that the solution is not more home births, but rather working with physicians to reduce hospital rates. Also, it must be recognized that the spike in C-section rates in recent years is also partly due to the increase in numbers of women choosing pregnancy after 35, and the increased numbers of women with obesity and diabetes.
The ACOG state that studies showing home births to be safer than hospital births are limited and have not been fully tested.
The ACOG urges women, who choose to have a midwife assisted birth, only to choose an ACNM-certified or AMCB-certified midwife and only to have their baby delivered in a hospital, a hospital based birthing center or an accredited free standing birth center.
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