The idea of a home birth is appealing to many mommas. In fact, recent birth statistics show over a 70% rise in planned out-of-hospital births since 2004. Home birth allows for mommas to experience birth as it was since the beginning of time. It increases the success of natural birth, is associated with far less medical intervention and celebrates the intimacy of childbirth.
The thing is, when you make the decision to have a home birth, you are often met with remarks from others (and maybe some personal thoughts too) about the safety factor. Hospital birth is so mainstream in our society that people often think home birth can’t possibly be safe, otherwise more people would do it.
Well, momma, in low-risk pregnancies home birth is considered just as safe an option as a hospital birth. Of course, there are some precautions home births mommas should take in the rare event that an emergency occurs.
How to make sure you have a safe home birth? Preparation and education.
- Make sure you are a good candidate
- Choose a certified and experienced midwife
- Get educated about home birth outcomes and stats
- Prepare yourself physically and mentally
- Learn about and prepare for possible hospital transfers and emergencies
Let’s unpack these 7 tips surrounding home birth safety to help you better prepare!
1. Make sure home birth is safe for you
The very first step when it comes to home birth safety is making sure you are a good candidate for home birth. We wouldn’t want you to get your heart set on a home birth to find out something about your pregnancy makes it too risky.
In general, a home birth is an option for you if your pregnancy is considered low-risk. But there are some other factors to weigh in.
What makes me a good candidate for home birth?
- You have no pre-existing medical conditions
- You are pregnant with only one baby
- You have no risks or medical conditions brought on by pregnancy (ie: preeclampsia or gestational diabetes)
- You’ve reached 37 weeks of gestation and didn’t go beyond 41 weeks
- You went into labor spontaneously (no induction needed)
- Your baby is in an optimal birthing position
- You are interested in natural childbirth
- You’ve had no previous pregnancies with preterm labor or other complications
- You’ve had no more than one previous C-section birth
When is home birth probably not an option?
- You have a preexisting medical condition that would require advanced medical monitoring
- You have high blood pressure
- You have diabetes or gestational diabetes
- You have a multiples pregnancy (twins, etc.)
- You have preeclampsia
- Your baby is not positioned optimally for birth
- You went into early labor (before 37 weeks)
- You’ve gone past your due date by over a week
- You’ve had past pregnancies with complication
If you don’t fit the criteria on the list, it is not recommended to proceed with a home birth. In fact, you will be hard pressed to even find a midwife to attend your home birth if you are not an ideal candidate. Remember this is for you and baby’s safety! It’s so important to trust in the guidance of your midwife and birthing team, your safety is paramount.
Additionally, as your pregnancy progresses, even if you are planning a home birth, there is always a chance that your midwife will advise a hospital birth in the end. You probably already realized this by looking at the list above.
This is because some of these complications or risk factors won’t come up until right before birth. For example, if baby is not in an ideal position for birth, you go into pre-term labor, or you need to be induced because of going too far past your due date.
2. Choose a well-trained and experienced midwife
The next safety tip surrounding home birth is in who you choose to attend your birth. Choosing to have a home birth means that you will be doing some extra legwork and preparation in making it a reality. The first of which is choosing a home birth midwife. This is definitely not a decision to take lightly!
You want a midwife that has had a variety of birth experiences and will know what to do should something go wrong. You need to trust your midwife to constantly evaluate the safety of home birth in your unique pregnancy, and who will know when to turn to the hospital during labor for any reason.
You also want to look for a midwife that has been professionally trained and can legally practice midwifery care in your state. An interesting aspect of home birth is that there is no federal legislation. Each state is different when it comes to allowing planned home births, and most specifically about who can attend them.
What types of midwives attend home births?
In general, there are two types of licensed and highly trained midwives you will come across when choosing a midwife for your home birth:
Certified Nurse Midwives (CNM)
CNMs are midwives that are registered nurses with a master’s degree in nursing midwifery from an accredited program. These midwives are trained medical professionals and have extensive training in pregnancy and birth.
CNMs are certified by the American Midwifery Certification Board and are legally recognized to practice in every state. CNMs almost exclusively deliver babies in hospital settings, but it’s not impossible to find one that will attend your home birth particularly if you live in a state that does not recognize CPMs. Currently, about 1/3 of all home births are attended by a CNM.
Certified Professional Midwives (CPM)
CPMs are not medical nurses, but are considered to be birthing professionals. CPMs receive training and certifications through the North American Registry of Midwives which involves coursework and a long and thorough apprenticeship program that requires attending 50+ births. Currently, CPM licensure is legally recognized in 33 US States.
CPMs are specifically trained and experienced in attending home births and deliver babies exclusively in birth center and home settings. These individuals are also trained in providing prenatal and postpartum care in addition to attending out of hospital births. This is the most common type of midwife to have at your home birth.
Interview your potential midwife
Once you know the difference between the two types of midwives, you are ready to start your midwife search. However, an important safety tip for your home birth is taking the time to interview your potential midwife.
Asking lots of questions is the best way to get a feel for your midwife’s experience and how comfortable you should feel with putting you and baby’s safety in her hands. For the most complete and comprehensive list of questions for your midwife, check out 102 Questions to Ask Your Midwife.
Here are some key questions to get you started, especially in the realm of home birth safety:
- What are your certifications and how long have you been practicing midwifery care?
- Do you work with a consulting physician?
- Do you have transfer rights at a specific hospital?
- What experience do you have with hospital transfer during home birth?
- What intervention and resuscitation devices and experience will you bring to my home birth?
- What experience have you had with complications of any kind during home births and postpartum care?
- How can we create a back-up plan as a team should something go wrong?
- What, in your experience, is the most common cause for a hospital transfer?
- In your words, what is the difference between a hospital transfer and an emergency hospital transfer?
- What steps can we take as a team to make safety a critical part of my home birth plan?
3. Get educated on natural birth and home birth outcomes
When it comes to birth, I always refer to it as the great unknown. Because even if this isn’t your first birth, you never know what each unique birth experience will bring.
One of the best ways to derail the unknown and some of the stress and anxiety that can accompany your birth is by arming yourself with natural birth stats and facts.
A bonus is that these can come in handy against those home birth nay-sayers you’re bound to encounter 😉
- Around 71% of singleton hospital births result in the use of epidural (source)
- Planning for a natural birth can decrease your risk for C-Section from 30% to 5% (source)
- Planned home birth is associated with less experience of significant tearing
- Planned home birth is associated with less experience of low birth weight
- Planned home birth is associated less use of episiotomy
- Planned home birth is strongly associated with unassisted vaginal delivery (source)
4. Prepare mentally and physically for your home birth
One aspect of home birth safety that you don’t want to overlook is the preparations you can make throughout your pregnancy. While these might not be what you typically think of when it comes to birth “safety”, approaching birth with a confident and relaxed attitude, as well as a well-prepared body, will go a long way in achieving the safe birth you desire.
What can I do to prepare physically for a safe home birth?
When it comes to physical preparation, preparing your muscles and body for childbirth can play a role in going into labor spontaneously, and having a labor that progresses naturally. Both of these are important aspects of safe home birth.
Another interesting fact is that poor sleep during pregnancy can put you at risk for pre-term labor, which would disqualify you from home birth completely. Be sure to sleep as much as possible and rest when you can.
Lastly, keeping your weight gain in check and paying attention to prenatal nutrition is a way you can physically prepare for a safer home birth, too.
What can I do to prepare mentally for home birth?
The best way to prepare yourself mentally for home birth is with education and relaxation. Knowing exactly what to expect in the birthing process and being equipped with strategies to manage pain will keep you calm and allow your home birth to progress safely and naturally.
You can achieve this by taking an online birth class, reading home birth and natural childbirth books, learning about hypnobirthing, reading and hearing birth stories, and watching home birth videos to teach and empower you.
5. Learn about what might cause a hospital transfer
When it comes to safety at your home birth, most often our minds immediately go to emergency situations and transfers to the hospital. Hospital transfers at home birth are actually far less common than many think.
True emergency hospital transfers account for less than 5% of all home birth hospital transfers (source). This is because your home birth midwife and birthing team will not let you proceed with a home birth to begin with if you aren’t considered a safe candidate.
However, this doesn’t mean you shouldn’t be prepared. Knowing why hospital transfers occur during home births is an essential safety preparation.
And if this is your first birth, it is important to know that around 30% of first births being attempted at home will be transferred to a hospital, typically due to extremely long or stalled labors.
Here are the most common reasons for a hospital transfer:
- Very slow to progress or stalled labor
- A request for pain medication by the birthing momma
- Meconium in your amniotic fluid (baby’s first poop)
- Red flags in momma’s vitals (ie: fever or high blood pressure)
- A change in baby’s position out of the ideal birthing position
- Excessive bleeding during or after birth
- Severe tearing after birth
- Cord prolapse
- Abnormal fetal heart rate
- Problems with baby transitioning to life outside of the womb
To read more in-depth about hospital transfer during home birth, head here.
6. Take steps to help prevent a hospital transfer
Part of the advantage of preparing so carefully for safety during your home birth is knowing the steps you can take to help your home birth progress smoothly. While some reasons for a hospital transfer are totally random and out of control, there is one that you can stack the odds against.
We know that the most common reason for hospital transfer is slow or stalled labor. This is especially true in first births. However, having a doula at your birth decreases your likelihood of needing Pitocin to speed up a stalled labor by 31% (source)! In other words, you will be 30% less likely to have a slow or stalled labor.
While having a doula is by no means a home birth requirement, it will definitely decrease your risk of hospital transfer due to stalled labor dramatically. Learn more about how to get a free or low-cost doula to make this your reality.
7. Have a detailed plan in place in the event of a hospital transfer
When it comes to home birth safety and hospital transfers, remember that less than 5% of all transfers are true emergencies, and transfers, in general, happen between 10-30% of the time depending on if it is your first birth.
However, you should ALWAYS plan and prepare for a hospital transfer in your home birth plan just in case you are in the minority.
When planning for a possible hospital transfer you should:
- Know the address of the nearest hospital and whether or not your midwife has automatic transfer rights at this hospital
- Do a dry run of going to the hospital and getting to both the Emergency Department and Labor and Delivery Department. Find out if there are special or limited entrances after hours
- Have a hospital bag packed and car seat installed in your car just in case
- Learn what types of hospital transfers would require an ambulance vs. driving yourselves
Safety is paramount at your home birth
When it comes to birth, in any setting, the goal of everyone involved is the safety of momma and baby. During your home birth, your midwife and birthing team should be constantly aware of you and baby’s safety and act accordingly.
You can ensure safety at your home birth by having an excellent midwife that is always evaluating your candidacy for a safe home birth throughout your pregnancy and labor. Beyond that, preparing yourself physically and mentally can also help you achieve a safe home birth by helping things progress naturally.
Finally, it’s important to prepare for the worst case scenario. Learning as much as you can about hospital transfers and birthing in a hospital will help streamline getting you there and getting the medical assistance you need if necessary.
Alright, momma– are you ready to keep learning as much as you can as you prepare for your home birth?
Don’t miss these articles:
