The research is clear: Homebirth with a skilled practitioner is as safe as hospital birth for low-risk women and, in some key ways, it can be safer. Peer-reviewed research on the safety of homebirth with skilled attendants (almost always midwives) abounds and continues to be conducted on an ongoing basis. This research clearly shows that homebirth offers some critical health advantages over hospital birth for healthy women. Some of the most significant are:
- Reduction in the chances of cesarean section. Even in Santa Cruz County, 29% of women undergo major abdominal surgery to deliver their baby. By comparison, the risk of cesarean section with a planned homebirth is about 4%. There are many reasons for this, but perhaps one of the most important is patience.
- Reduction in rates of infection, for you and your baby. The germs in your environment are familiar to you. Additionally, hospitals don’t just have laboring women; they also have lots and lots of sick people, as well as drug-resistant strains of infectious agents. Homebirth midwives are generally less interventive, which cuts down infection from IV sites, episiotomy, cesarean section, and vaginal exams.
- Better early bonding with your baby. Mothers can bond with their babies everywhere and, of course, they do. But the Midwifery Model of Care includes as a key priority to keep the mother and baby together and consider them a unit. I minimize interruptions and distractions to this critical bonding time. In the absence of a serious problem, your baby will remain on you skin to skin, and anything that needs to be done will be done at your side. You cannot get those first hours after birth back, so consider a care provider and environment that makes bonding a priority.
- Truly individualized care. Because you will have spent more than a dozen hours with your midwife before your labor, she has intimate knowledge of your deepest hopes, fears, and wishes for your birth. You share a connection that goes beyond simple “health care provider” and “patient” roles. In the hospital, there is no guarantee that your doctor or midwife will even be at your birth. Want a water birth? It’s only possible in Santa Cruz County if you give birth at home.
What about complications? Complications are less likely at home because we are not using medications in labor that can make birth more dangerous for mother and baby. In an otherwise low-risk birth, complications that occur in the hospital can be caused by the very interventions being used to solve another issue: for example, using Pitocin to speed up the labor can cause the fetus to go into distress; epidurals can be amazing but they can cause the woman’s blood pressure to dip significantly, also resulting in fetal distress. Don’t get me wrong, these tools and interventions are amazing and can help to ensure good outcome. However, in modern obstetric care, they can be overused and their risks diminished.
Additionally, most problems present with warning signs well in advance of an emergent situation and can be resolved safely at home and/or with time to transfer to the next level of care if necessary. Although infrequent, the most common reason for transport from a homebirth setting is lack of progress in labor, a non-urgent situation.
I carry oxygen, resuscitation and suctioning equipment, pharmaceutical medications to control hemorrhage, and other items to handle emergent situations. Most situations can be handled just fine in the home setting, and I always have a timely transport plan in place, as well as a second skilled attendant to assist at each birth.
As a midwife, I do not believe that home is always the best place for birth. While I believe passionately in the power of women to birth their babies naturally, I do not have a philosophy of homebirth or bust. There are occasional times when the “bells and whistles” that the hospital has to offer are prudent to protect the safety of you and your baby. More frequently, a woman with a long, non-progressing labor would benefit from the tools the hospital has for enhancing labor and offering deep rest. I will remain with you through your labor and birth, even if we go in to the hospital, to help you to have your best birth in that setting.
We will talk about this in depth during the interview and prenatal appointments.
Kelly Olmstead, LM, CPM 