Why Homebirth is a Safe Alternative for Low-Risk Birthing Individuals

For birthing individuals, there are multiple prenatal care provider options available. Available options include obstetricians, certified nurse midwives, and direct-entry midwives. When choosing a direct-entry midwife as a primary care provider, the birthing individual is consenting to receiving care out of the traditional hospital setting. This means that the birth of their child will take place either at home, or at a birth center provided by the midwife. From 2004 through 2017 in the United States, the rate at which people have chosen to have a homebirth has increased by 77%. With the increase in demand for out-of-hospital prenatal care, there has been increasing speculation on the safety of homebirth and if it can be considered a responsible option for delivery. In 2011, the Birthplace in England national prospective cohort study showed that there are no significant differences in the primary outcome for both birthing individuals and babies when birth takes place in an out-of-hospital setting versus an in-hospital setting. Over 20 years of statistical data provided by a famous birth center in Tennessee known as the Farm concludes that planned home births attended by direct-entry midwives can be accomplished with the same level of safety and with a lower intervention rate than physician-attended hospital deliveries. Home birth is a safe and appealing option for birthing individuals having low-risk pregnancies because of the level of training that direct-entry midwives obtain and the model of care that they practice, the benefits that homebirth offers to the birthing individual, and the benefits homebirth offers to the newborn baby.


Direct-entry midwives are required to attend on average 4 years of schooling specific to the care of gestating individuals. This education covers how to care for people from

pre-conception through the postpartum period. Direct-entry midwives are thoroughly trained on how to educate and support their clients to have the healthiest pregnancy possible. This is done through educating clients on how to nourish their bodies both physically and mentally. While teaching clients how to support their pregnancies to the best of their abilities, midwives thoroughly assess their clients vitals, bloodwork and other indicators that indicate if their pregnancy is one that can be safely supported by midwifery care. In order to be cared for under the midwifery model of care, the client must meet certain requirements that have been proven to indicate if there are complications arising during the pregnancy. During the late 1900’s study performed at the Farm, childbearing individuals with “preexisting diabetes, Rh negative blood with positive antibody screens, weight greater than 135 kg, and hematocrit on intake lower than 28 were considered ineligible for care” ( Duran, A. M. (1992). As studies have continued to be published, and midwifery care has evolved, these risk factors have been adjusted to be able to best assess if midwifery care is suitable for the child-bearing individual. Due to the vigorous training midwives are required to obtain and the detailed assessments that are performed in prenatal care leading up to an out-of-hospital delivery, homebirth is a safe and effective option for low-risk pregnant people to consider.


Home birth offers low intervention rates to the birthing individual. A study conducted by the National Health and Medical Research Council in Australia from the year 2005 until 2010 showed that “of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so” (Catling‐Paull, C. et. al). In the United States, the rate of cesarean birth has been slowly increasing. As of 2016, the cesarean birth rate was 31.9% nationally (Patel, B.S. et. al), almost double what most studies show as an average intervention rate for home birth. Reasoning for these statistical discrepancies stem from the different approach that homebirth takes towards supporting the birthing individual during labor. Laboring in the comfort of one’s home with consistent perinatal support from a trained midwife optimises the production of oxytocin, a necessary hormone for progressing labor (Perez, Anna, 2020). Midwives oversee one birth at a time, maximizing continuity of care. This has been associated with “increased rate of spontaneous vaginal births, shorter duration of labour, higher Apgar score, decreased rate of instrumental deliveries, decreased use of analgesia, and improved maternal experience” (Perez, Anna. 2020). The low intervention rate that midwifery care offers makes homebirth a safe and desirable option to birthing individuals.


Similar to the reasons home birth offers lower maternal interventions, it is also conducive to lower neonatal interventions. When the laboring individual is consistently supported during labor, it can directly correlate to the wellness of the neonate. It can lead to better APGAR scores following the birth of the baby (Perez, Anna. 2020). Following the delivery of the neonate, the midwifery model of care recognizes the importance of skin-to-skin connection between the baby and the parents. Allowing for the baby and parents to have time to connect directly correlates to the success rate of breast feeding long term (Perez, Anna. 2020).


Due to the level of education that midwives obtain, the model of care that midwifery practices, and the benefit that home birth offers to both the birthing individual and their baby, home birth is a safe and appealing option for low-risk birthing individuals. Home birth is a safe option for all low-risk childbearing people who are interested in experiencing birth under a different model of care than what is offered in a hospital setting.



Sources:


  1. Catling‐Paull, C., Coddington, R.L., Foureur, M.J. and Homer, C.S.E. (2013), Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Medical Journal of Australia, 198: 616-620. https://doi.org/10.5694/mja12.11665

  2. Cheyney, Melissa, PhD, CPM, Bovbjerg, Marit, PhD, MS, Everson, Courtney, Gordon, Wendy, et al. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery and Women's Health, 59, 17-27. https://doi.org/10.1111/jmwh.12172

  3. Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D. and Vedam, S. (2014), Development and Validation of a National Data Registry for Midwife‐Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset. Journal of Midwifery & Women's Health, 59: 8-16. https://doi.org/10.1111/jmwh.12165

  4. Duran, A. M. (1992). The safety of home birth: the farm study. American Journal of Public Health, 82(3), 450–453. https://doi.org/10.2105/ajph.82.3.450

  5. How to Become a CPM | NARM. (n.d.). NARM. Retrieved March 9, 2021, from https://narm.org/certification/how-to-become-a-cpm/

  6. Olsen, Ole. (1997). Meta-analysis of the Safety of Home Birth. Birth, 24(1), 4-13. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=yrovftc&NEWS=N&AN=00001857-199703000-00002.

  7. Patel, B. S., Kedia, N., Shah, S. R., Agrawal, S. P., Patel, V. B., & Patel, A. B. (2020). Changing trends in cesarean section: from 1950 to 2020. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9(5), 2222. https://doi.org/10.18203/2320-1770.ijrcog20201842

  8. Perez, Ana. (2020). Holistic care in midwifery-led birthing units. MIDIRS Midwifery Digest, 30(1), 66-70. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=yrovftw&NEWS=N&AN=00115386-202030010-00013.

  9. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. (2011). BMJ, 343(nov23 4), d7400. https://doi.org/10.1136/bmj.d7400

  10. Young, K. A., Wise, J. A., DeSaix, P., Kruse, D. H., Poe, B., Johnson, E., Johnson, J. E., Korol, O., Betts, G. J., & Womble, M. (2013). Anatomy and Physiology by OpenStax (hardcover version, full color) (1st ed.). XanEdu Publishing Inc.

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