Home Delivery: What is Safe?
Donald Aulds, M.D.
Dr. Donald Aulds is a practicing OB/GYN. As a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists, he shares their views and opinions on the subject of home delivery.
In the past several years, there has been more interest in whether home births are safe and the option of home birth for the pregnant woman. The American Medical Association and the American College of Obstetricians and Gynecologists advocate that an accredited birthing center or a hospital “is the safest setting for labor, delivery and the immediate postpartum period.” Advocates of home birth seem to have only one main argument -- that the option of home birth empowers a woman to choose the way she wants to deliver. A recent article in the Baltimore Sun accused doctors of strong-arming women away from alternatives to hospital care. This article will present data and offer topics of discussion.
What data supports hospital or home birth?
- In 1940, 44 percent of all births were outside the hospital and the maternal death rate was listed as more than 600 deaths for every 100,000 births in the U.S.
- By 1960, more than 96 percent of all births in the U.S. were delivered in the hospital with a reported maternal death rate of less than 30 per 100,000 births.
- In a recent study published by home birth advocates, the maternal death rate was listed as 12 per 100,000 home deliveries. This number excludes those women who were transferred to a hospital for care when home birth was not successful or when a woman developed a complication.
- Studies from England show that less than 2 percent of all deliveries are outside of the hospital, and the maternal death rate is less than 5 per 100,000 births.
- A recent study from The Netherlands showed that that 30 percent of all births are outside of the hospital, and of the women electing home birth, more than 31 percent had to be transferred to a hospital for delivery. A note made by the author of the study: “The Netherlands is a very densely populated country where the average distance to the hospital is relatively short.” This cannot be said of all countries where large rural populations exist.
- A 1990s Australian study reported infant death to be 50 out of 7,002 home births. For babies more than 5 pounds at birth, 5.7 fetal deaths per 1,000 births occurred at home compared to 3.6 per 1,000 births in the hospital. Maternal death was also higher with home birth: 2.7 per 1,000 births at home compared to 0.9 per 1,000 births in the hospital. The author of the study attributed the deaths to post-term deliveries, twin delivery complications, breech deliveries and inadequate response to fetal distress.
Are there risks for having a water birth?
The major risks of water birth have included infections, drowning of the infant, snapping of the umbilical cord with blood loss for the baby and deaths of the infant within the first couple of weeks after birth. The available data has led the American Academy of Pediatrics to issue a statement that “underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed randomized clinical trial after informed parental consent.” A recent study of 4,030 births in water showed that 35 infants suffered severe disorders including sepsis, meconium aspiration, drowning, pneumonias and severe anemia due to snapping of the umbilical cord. Another study done on water pools in birthing centers showed that cultures of the water in the pools grew out E.coli, bacteria from stool, enterococcus and staph. After special water filters were installed, the cultures improved but were still contaminated. The author of the study stated: “The water in a birth pool, conveniently heated to body temperature -- the optimum temperature for bacterial growth -- is a microbial paradise.”
Home birth advocates cite in their studies that only “low-risk” women are accepted for home delivery. Who decides if a woman and her pregnancy is “low-risk?” Another factor that has to be considered is the training of the person assisting with the delivery. In the U.S. there are three types of midwives: certified nurse midwife (CNM), who is a registered nurse with extensive formal training and examinations; certified midwife, who is also formally trained and certified by examinations; and professional midwife, who has to attend a minimum of 20 deliveries and manage 20 additional deliveries (a high school diploma is not even required).
All of these factors must be considered when a woman makes the decision to consider home delivery. Check the credentials of the person you trust your life and the life of your baby to. Home delivery is not going away but you have to make sure that the environment is safe and the options are considered thoroughly.