Planned home birth

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Planned home birth
Reviewed by the BabyCenter Medical Advisory Board
Last updated: September 2008

Should I consider a home birth?

If you're a healthy expectant mother having a normal pregnancy and you have no medical or obstetrical risk factors, giving birth at home may be an option for you.

Giving birth at home allows you to labor and deliver in familiar and comfortable surroundings. You'll have more control over your birth experience than you would in a hospital, and you won't have to endure routine medical interventions.

At home, as many family members or friends as you want can attend the birth, and you get to share the experience with them in the privacy of your own home, without interruptions from hospital staff. And all of your caregiver's attention will be focused on you and your baby.

For a sense of what a home birth can be like, read Julie Tilsner's funny and heartwarming journal entry describing how she delivered her son Jackson at home with the help of two wonderful midwives, and Roberta Rennie's story of her home birth in a tub.

Giving birth at home isn't for everyone, of course. Moms-to-be who are more likely to have complications during childbirth should give birth in a hospital. This includes women with:

* Medical conditions, such as high blood pressure or diabetes
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* A previous c-section or other uterine surgery
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* Pregnancy complications, such as premature labor, preeclampsia, twins (or more), or a baby in the breech position at 37 weeks


If you choose to have a home birth, it's important to be flexible and understand that if complications arise, you might have to transfer your care to another provider or give birth in a hospital.

You'll also need to be committed to giving birth without medication, preparing your home for the birth (including getting whatever supplies your caregiver recommends), and making plans to ensure that you have good support available to you in the days after you give birth.

Another consideration: Not all insurance companies and HMOs cover the cost of home births.
Is giving birth at home safe?

For healthy women at low risk for complications who choose skilled and experienced caregivers and have a good system in place for transfer to a hospital when necessary, a number of studies show that giving birth at home is just as safe as giving birth in a hospital. There is also research showing that moms who planned to give birth at home (regardless of where they actually had their babies) ended up with fewer interventions, such as episiotomies and c-sections, compared with a group of equally low-risk women who had planned hospital deliveries.

But home birth remains controversial in the United States. The American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) oppose home birth. They contend that the hospital is the safest place to give birth because capabilities of the hospital setting and the expertise of the hospital staff are immediately available if a complication arises suddenly.

On the other hand, both the American College of Nurse-Midwives and the Governing Council of the American Public Health Association support the choice of women who are good candidates to give birth at home. They say that qualified caregivers, along with appropriate arrangements for backup and transfer, should be available for moms-to-be who want this option.

If you're not sure whether you have medical or obstetrical problems that would keep you from having a home birth, contact a home birth provider and share your concerns over the phone. If there are no obvious reasons to rule out a home birth, you can make an appointment for a first prenatal visit.

At that visit, the caregiver will do a detailed history and physical exam, as well as the usual set of lab tests. She'll continue to assess your situation throughout your pregnancy and during labor, birth, and the postpartum period.
What else can I do to make sure that my home birth is as safe as it can be?

Find a good practitioner

Look for a certified nurse-midwife (CNM), a certified direct-entry midwife (CPM or CM), or a physician with plenty of experience delivering babies at home. Ask about her education, her credentials, and whether she's licensed to practice in your state.

Be sure your caregiver carries the necessary equipment and supplies to start emergency treatment if needed, such as infant resuscitation equipment and oxygen, IVs, and medication to stem postpartum bleeding. It's also critical to make sure that she has an arrangement for backup with a qualified doctor and a nearby hospital in case you need to be transferred.

Make sure your backup plan is solid

Make sure the backup hospital is relatively close and that your transportation there is fail-safe in case something goes wrong and you need to get to a hospital quickly.

Find a supportive doctor for your baby

Establish a relationship in advance with a pediatrician or family doctor (or group of doctors) in your community who'll be able to see your baby a day or two after he's born and is, ideally, supportive of your choice to deliver at home. (Your caregiver should be able to recommend one.)

Line up postpartum help

Arrange for extra help at home in the days following delivery. It's great if your partner can manage to take time off work to help you and to share this special time. If your partner can't (or if you want extra help), have a relative or friend come to stay for a few days, or hire a postpartum doula.
How much does a home birth cost?

The fees for home birth practitioners vary considerably from place to place and among caregivers. It's a good idea to find out not only what the home birth will cost but also what additional expenses you'd have to pay if you needed to be transferred to another provider or a hospital during pregnancy, labor, birth, or postpartum.

Some insurance carriers cover home birth, but others don't. If you have insurance through an HMO that doesn't have an in-network provider who does home births, you may be able to get the HMO to provide some coverage for an out-of-network provider, although you'll probably have to be persistent.
How can I find a caregiver to attend my home birth?

Some resources to start with:

* The American College of Nurse Midwives in Washington, D.C., can direct you to home-birth resources in your area, including a list of certified nurse-midwives. You can call the organization at (240) 485-1800 or visit its website.


* The Midwives Alliance of North America is an organization for both direct-entry midwives and certified nurse-midwives. For a list of members in your state, e-mail the alliance at membership@mana.org, or call (888) 923-6262. You'll find some information about home births on the group's website.


* Ask a childbirth educator in your area or contact your local La Leche League.

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