Home Birth Safety

The Childbirth Connection is an organization committed to helping expectant parents and health professionals make informed maternity care decisions. This organization is an extensive resource in exploring and understanding the options of where to seek maternity care and whom to seek it with.

The World Health Organization states “that a person should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible. For a low risk pregnant women and people, this can be at home, at a small maternity clinic or birth center, in town or perhaps at the maternity unit of a larger hospital. However, it must be a place where all the attention and care are focused on the their needs and safety, as close to home and their own culture as possible.”

Review and Research about Home Birth:

– In August 2019, Science Daily published this recent review of home birth studies from several countries including the United States, published in the Lancet; the review concluded that planned home birth with a trained attendant does not increase risks to the baby.

– This study from the Canadian Medical Journal in 2015 concluded that planned home births attended by midwives where home birth was well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions.

– This study published in the Journal of Midwifery & Women’s Health in 2014 included over 16,000 planned home births in the United States attended by Certified Professional Midwives. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.

– This study in 2018 found that the more integrated U.S. midwives are into the system — based on criteria like licensing and insurance coverage — the better a state’s birth outcomes are.

– In June of 2015, the New England Journal of Medicine featured an article by physician, Neel Shah, about home birth in the US and in the United Kingdom. The UK’s National Health System, in 2014, recently recommended that home birth may be the safest option for women and people experiencing a low risk pregnancy.

The Cochrane Library review, concluded in 2012 that “studies suggest that planned hospital birth is not any safer than planned home birth assisted by an experienced midwife with collaborative medical back up.” The mechanisms in place to seamlessly transfer care if necessary continue to appear throughout the literature.

Maternity care is so much more than just physical safety; it involves emotional safety as well. The link here takes you to a beautiful video made by the White Ribbon Alliance honoring respectful maternity care as a human right.

Midwifery Community Standard of Care
The Midwifery Model of Care is centered on reducing medical intervention and maintaining safety for pregnant women or pregnant people, and their children. The Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the woman or pregnant person throughout the childbearing cycle
• Providing the woman or pregnant person with individualized education, counseling, and prenatal care, continuous hands on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring clients who require obstetrical attention

As a Licensed Midwife, I follow the community standards of care: providing continuity of care, assessing a person’s contextual health and well-being, providing education on nutrition and exercise, and offering routine laboratory screening and testing in pregnancy. The prenatal period also offers a unique opportunity for midwives to make home visits and assess safety and well-being at home. As needed, midwives will refer clients to a clinic or hospital-based provider if signs of complications develop. The Wisconsin Department of Safety and Professional Services lists the requirements for Licensed Midwives for referral and consultation with a physician.

In labor and delivery, the community standard is to carry a fetal doppler to asses fetal heart tones, anti-hemorrhagic medications including pitocin and methergine, oxygen for both mother and baby, a bag and mask to deliver oxygen, IV equipment, and IV fluids. Midwives providing out of hospital care have current certification in neonatal

resuscitation as well as adult CPR. Many of the issues that arise for healthy expectant women, pregnant people, and babies can be handled with these initial measures at home, measures that are similar to a level I hospital.  For those needing medical care in a hospital setting, transfer of care will be initiated while the midwife accompanies their client during the transfer. It may be helpful to visit a physician or hospital-based midwife during the prenatal period to make this transfer occur as smoothly and efficiently as possible.

After the birth, the community standard is to continue to provide ongoing postpartum care and support until 6 weeks. This care includes weight checks, jaundice evaluations, lactation support, newborn screening, birth certificate filing and full guidance until the well-being of postpartum mother or parent, and baby is established. As always, midwives will refer clients to a clinic or hospital-based provider if signs of complications develop.