In the United States, 1% of births occur in homes or birthing centers, with the rate continuing to increase steadily. (Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. 2014) Women of all ethnicities, backgrounds, and economic status choose to have a home birth. Midwives are skilled professionals in the birthing setting, and are trained to recognize and manage complications in the prenatal period, labor, and postpartum. Midwives are usually the primary care providers attending home births. Midwives offer appropriate care in determining if a pregnant women is a good candidate for a homebirth in terms of being low risk for complications such as diabetes, hypertension, Rh- negative blood type with positive antibody screening, preeclampsia, among others. (Durand, M. 1992) Studies have shown that healthy, low risk women having a homebirth attended by a midwife results in positive outcomes and benefits for mother and newborn. (Durand, M. 1992) Midwives in a home birth setting are equipped to handle complications in case of emergency. The benefits are less unnecessary interventions, better outcomes for mother and baby, and appropriate continuity of care to assess situations. Many people question the safety of homebirths due to the vague information that sources and media provide. Debates on the data of safety of home births has been confused by inaccurate studies and statistics. Many of these studies showing that home birth was not a safe option included planned home births, and unplanned home births without skilled care providers. (Horn, A., 2008) These inaccurate statistics have very little relevance to the safety of a planned homebirth, with a low risk mother and a skilled professional. There is an accurate landmark study examining 16,924 midwifery-led pregnancies from 2004 to 2009 that confirm the positive outcomes and increased benefits to mothers and babies. (Cheyney, M. et al., 2014) Out of this study, 89.1% of women birthed at home. 93.6% of births were intervention unassisted vaginal births. There is no evidence that hospital birth is safer than home births for women at low risk of complications, planned home births, and with a skilled care provider. (Cheyney, M. et al., 2014) A concern for many people is what happens in case of an emergency and if a midwife is equipped with the appropriate tools to deal with complications. Midwives are skilled to assess and manage potential complications that could arise and provide preventative measures such as establishing a safe infrastructure in case of obstetric intervention. (Horn, A, 2008) They are equipped with emergency medications such as pitocin for hemorrhage, a doppler or fetoscope to check fetal heart tones, sterile instruments for cord clamping and cutting, suction device to remove mucous, oxygen tank, resuscitation tools along with other equipment and remedies to prevent, and manage complications. Midwives monitor fetal heart rate, blood pressure, pulse, progress, state of mother and of baby during labor. They also stay with the mother the majority of the labor, which allows better assessment of the labor. Women having home births have been shown to have lower risks of operative birth interventions such as operative vaginal births using forceps and vacuums, epidural analgesia, induction of labor and cesarean section. (Johnson, K. C, 2005) Elective obstetric interventions which are used more frequently in the hospital, may increase the risk of various outcomes in low risk women, creating a high risk situation. Usage of forceps increases the risk of infant fetal nerve injury and 3rd and 4th degree perineal lacerations of the mother. The usage of a vacuum increases the risks of subarachnoid hemorrhage, brachial plexus injury, and cephalhematoma. (Althabe, F. 2002) Epidural analgesia is used as a pain relief in labor to mothers. However, it comes with many side effects such as hypotension, itching, shivering,fever, urinary retention, dural puncture, nausea, vomiting, sedation, fetal bradycardia, ringing in ears, damaged pelvic floor due to maternal exhaustion, and increasing the risk of cesarean birth. (IQWiG, 2012) Induction or augmentation of labor also has various risks involved. Pitocin is a commonly used drug in hospitals to induce labor and some of the maternal risks are an increased risk for postpartum hemorrhage, high blood pressure, rupture of the uterus, allergic reactions, nausea, vomiting, seizures, excessive weight gain, pelvic hematoma, and severe headaches. Studies have shown that induction with pitocin may not be as safe for full term babies are previously believed. The use of pitocin increases the risk of a newborn in the NICU lasting more than 24 hours. Apgar scores, which evaluate the condition of the baby such as appearance, heart rate, grimace response, muscle tone, and respiration has been shown to be lower in newborns with the use of pitocin. (ACOG, 2013) The risks of cesarean section are hemorrhage, infection, thromboembolism, and weakening the uterus. Risks of cesarean section for the fetus are transient respiratory distress, retention of anesthetic, along with other traumas. (Berland, M, 1986) Planned home births have shown to be a better outcome for low risk pregnancies, benefiting mother and baby. (Johnson, K, 2005) Operative vaginal delivery and cesarean section in the home birth group of women was lower than what was reported in hospital based US samples, along with lower rates of hemorrhaging, and 3rd and 4th degree perineal lacerations. Measures of maternal morbidity was also lower in the planned home birth group. Out of the study of 16,924 pregnancies, 89.1% were home births, with a transfer rate of only 10.9%. The rate of neonatal death was 0.88 per 1000. 92% of the babies born were full term. Vaginal birth after cesarean section was 87% with home births. 57.2% of breech babies were also delivered vaginally in this study. (Cheyney, M., et al, 2008) Home birth provides continuity of care for mother and baby, which is a factor that makes it safer for mother and baby. With quality postpartum care from midwives, the mother and baby’s situation are able to be monitored more closely. Quality continuity of care can prevent infant and maternal morbidity. (Cheng, C., Fowles, E., & Walker, L., 2006) Home visits after delivery has shown to decrease depression in women with family dysfunction of postpartum depression. Continuity of care is preventative and allows the mother and baby to get the proper care that they need for the postpartum period. (Cheng, C. et al, 2006) Homebirth is a safe option when planned, low risk, and with a skilled care provider. Birthing at home has positive outcomes in various aspects of delivery. Care providers are equipped with the appropriate tools and instruments in case of emergency at the home setting. Some benefits to planned home birth are less interventions, better outcomes for mother and baby, and continuity of care that allows proper assessment of the postpartum period.
References ACOG. (2013). Study finds adverse effects of pitocin in newborns. Retrieved from http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Study-Finds-Adve rse-Effects-of-Pitocin-in-Newborns Althabe, F. (2002). Vacuum extraction versus forceps for assisted vaginal delivery. Retrieved from http://apps.who.int/rhl/pregnancy_childbirth/childbirth/2nd_stage/cd000224_althabe_co m/en/ Berland, M. (1986). Risks of cesarean section. Revue Francaise de Gynecologie et D’obstetrique. 81(4), 187-90, 193-4. Cheng, C., Fowles, E., & Walker, L. (2006). Postpartum maternal health care in the United States: A critical review. The Journal of Perinatal Education. 15(3), 34-42. Doi: 10.1624/105812406X119002 Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of care for 16,924 planned homebirths in the United States: The Midwives Alliance of North America statistics project, 2004 to 2009. Journal of Midwifery & Women’s Health. 59, 17-27. Doi: 10.1111/jmwh.12172 Running head: Safety of Homebirth 7 Durand, M. (1992). The safety of homebirth: The farm study. Journal of American Public Health Association, 82, 450-452. Horn, A. (2008) Home birth: All you need to know. [Data file]. Retrieved from http://www.nct.org.uk/system/files/related_documents/Home%20birth%20booklet_5.pdf IQWiG. (2012). Pregnancy and birth :Epidurals and pain killers for labor pain relief. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072751/ Johnson, K. C., & Daviss, B. A. (2005). Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ, 330, 1416. doi: 10.1136/bmj.330.7505.1416