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 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.”
In August 2019, a recent review of home birth studies from several countries including the United States, published in the Lancet, concluded that planned home birth with a trained attendant does not increase risk to the baby. Other studies (this one out of Canada, and this one that included CPMs in the U.S., among others) attest to the benefits for the birth mother, such as less physical injury, less chance of surgery, and more success breastfeeding. The Cochrane Library, which conducts reviews across medicine to inform evidence-based practice, concludes 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.” That there are mechanisms in place to seamlessly transfer care if necessary is a caveat that appears throughout the literature. Another recent study 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 people experiencing a low risk pregnancy.
ACOG published their support and recommendations for low intervention birth here.
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 people and their children. The Model of Care (Midwifery Task Force, Inc.,1996-2008) includes:
- Monitoring the physical, psychological, and social well-being of the pregnant person throughout the childbearing cycle
- Providing the 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 people 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 medical 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 parents 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 parent and baby is established. As always, midwives will refer clients to a physician if signs of complications develop.