Monday, March 5, 2012

Are Home Deliveries Safe?

I'm pleased to host Tanya Cunningham today as she discusses the safety of home deliveries. I think this is another one of those instances where some important information is not as prominent as what is portrayed by celebrities and others.

What do you think? Welcome, Tanya!

The birth of a new baby is a life changing, exciting event in the lives of the expecting mother and father to be. The number of decisions to be made are numerous and often overwhelming. One question many expecting parents ask is whether to give birth in a hospital setting or at home with the aid of a certified nurse midwife (CNM).

Although there are benefits to both hospital and home births, the American College of Obstetricians and Gynecologists does not recommend home births due to a concern for safety and a need for much more research according to Dr. Joseph R. Wax of Maine Medical Center in Portland.

The benefits of home births that appeal to expectant mothers include a more relaxed or therapeutic setting, decreased risk of tearing and episiotomies, decreased risk of hemorrhage, decreased risk of infections, and a sense of autonomy concerning her birth plan.

In a systematic review of literature by Laurie Barclay, MD and Hien T. Nghiem, MD, they found that planned home births have a worrisome neonatal mortality rate triple that of hospital births, despite similar perinatal mortality rates. So while an actual delivery may go as planned, triple the number of newborns die in the first month of life after a planned home birth.  Barclay and Nghiem also found the 9% of parous (repeat mothers) and 37% of nulliparous (first time mothers) had to be transported to the hospital during planned home labor.

Other safety concerns I personally cannot ignore is the “what if” factor. Hopefully everything does go as planned whether delivering at home or at a hospital, but what if the new mother does hemorrhage in the postpartum period? The amount of blood loss in minutes can be catastrophic, and if it's me, I want to be in a hospital setting where quick and timely interventions such as an emergent blood transfusion can save my life.

Another example is fetal distress. If severe or prolonged enough, an emergent or “crash” c-section may be a necessity. Again, if it's me in the delivery room, I take comfort knowing an OR is seconds away if needed.

I love the idea of the home delivery, but I don't love the realities. The reality is, even in the most straightforward, low risk pregnancies, unforeseen and even emergent complications can occur during labor and delivery. I do feel the OB hospital setting and staff have been vilified a bit, as time driven, heartless wardens chaining the laboring woman to a hospital bed with fetal monitoring against her will.

As a postpartum RN, I can assure you our first interest is the health of the mother and baby. As long as their well being isn't compromised, mothers are encouraged to labor as they wish. At the hospital where I work, women are free to roam the halls and utilize birthing balls and birthing tubs. There are many women who deliver naturally, and their birth plans are respected and followed.

If you've had a negative experience in a hospital setting delivering a baby, feeling rushed by medical interventions or that a c-section might have been premature, remember, that may be more of an issue with your health care provider or the staff working at the time. I'd encourage you to research doctors who are more flexible and work with expectant/laboring mothers to follow their birth plans as closely as possible.

We who are in the business of delivering and caring for new mothers and babies seek to be as therapeutic as possible, but there are times when medical interventions are necessary to protect the health and well being of either the mother or baby. While delivering a baby at home might be more desirable to an expectant mother as far preserving her autonomy, the truth is hospital deliveries are safer. If you're expecting or planning to have a child in the future, be sure you make an informed decision when considering where to deliver your precious little one.


Tanya Cunningham is a mother/baby RN and lives in Missouri with her husband and two small children. She has been caring for mothers and their newborns for almost four years, before which she was a RN in the USAF. During that time, Tanya worked on a multipurpose inpatient unit for two and a half years (taking care of ortho, neuro, medical, general surgical, and tele) and a family practice residency clinic for a year and a half. Tanya earned her BSN at Oral Roberts University.
Tanya has been writing children's stories for almost 2 years now and is working towards being published. She enjoys raising her children, cooking, and reading medical suspense/mysteries, especially those in Christian Fiction. You can find out more about Tanya by visiting her website.


  1. I had two home births. One was planned with a medical doctor coming to my home. My mother was horrified.

    That doctor retired and the next birth, we could not get a doctor to agree to come. But after about a month of false labor and spending one whole night in the hospital with my stubborn little guy, he was finally born at home. Sigh.

    Life is full of interesting experiences. We had three hospital births. We won't go into all that at this time. Sigh.

  2. Sharon, I'm happy to hear when home deliveries go as planned, but I have to say I
    when I know of a friend or family member delivering at home, I pray for a good outcome
    and that they won't fall victim to what statistics show us.

    It sounds like your hospital deliveries weren't ideal. I believe OB physicians and nursing
    staff are working to make hospital deliveries more therapeutic for the delivering mother.
    Gone are the days when the doctor is god and the patient has no say. It's about
    communicating your expectations and maintaining a mutual respect between patient
    and doctor. I emphasize again to anyone reading, if you feel your delivering physician
    or nursing staff are not respecting your birth plan or wishes without sufficient medical
    reason, protect your rights. All hospitals now have patient advocates who assist patients
    in communicating their perspective to hospital staff. Feel free to utilize them.

    This is a personal issue many mothers and medical staff are highly passionate about and
    with good reason. Thanks for sharing your experiences, Sharon! :)

  3. I fully agree that a Mom should be able to have what she feels is the best option for her concerning a delivery. However, they often don't have the understanding or knowledge of all the "what if's." Seems simple. "If I have trouble, I'll just go to the hospital." The question is, will you know you're in trouble or the baby is in trouble in time to get to the hospital? For a baby in distress, seconds are precious. And as one who has been called to "pick up the pieces" medically when things have gone awry at home, it is very difficult to come into the middle of a situation and have a good outcome despite all the "miracles" of modern medicine. There is a reason that people stopped having home births and it transitioned to the hospital birth in the first place! I completely agree with Tanya. Advocate for yourself and your baby concerning your worries about a hospital birth. But at the same time, respect that they have years of knowledge and education to make sure things are safe for you and the baby and an IV may not be your desire, but having one may save your life in case of emergency.

    Tanya, thanks for the statistics. We have 2 lay midwives in our area and as a CRNA, I am asked about home births by couples considering it. I had my personal opinions but I am glad to have actual statistics to cite.

    1. Great points, Kim! Glad you stopped by. It's always valuable hearing the anesthesia point of view on such an important topic.

  4. In my child bearing years, hospital births were horrifying--legs strapped, shaved and given enemas and institutional. For my daughter, the process was like being at home with non of my horrors.

    That said, my daughter had to be delivered with forceps. I was minutes from a c-section. I ended up hemororaging (after discharge). My sister-in-law ended up with ecclampsia and nearly died. (Please forgive my non-medical spelling.

    With life-threatening issues facing both mother and child, there is no way I would have a home birth or recommend one. 9/10 times (my stats) they're fine. I could never forgive myself if that 10th time was mine and my child died.

    Very interesting blog.

    1. Carol,

      I like your point and I think that's a question to ask if you are considering a home delivery. Are you fine with the undesirable outcome if it happens? As Kim noted above, by the time you get to a hospital, it may be too late to do anything to help the mother or the baby.

  5. I'm an OB/GYN. I strive to provide the best care for my patients. I am very flexible. I encourage ambulation, a warm showers, the "hospital hot tub" (not overly hot), birthing balls, bars, you name. If all is going well, yes, please do what gives you comfort. I do not cut episiotomies (unless I have no choice) and I employ mineral or olive oil to help stretch the perineum. I am happy to report that I deliver many women without lacerations. That being said, the cozy family friendly labor rooms are seconds away from the operating room should emergent or nonemergent surgical intervention is readily available. Why take a risk with you and your baby?

    1. Thanks, Dr. Goodwin. It's sounds like your methods are the ideal and what all
      OB/GYN's should emulate!

    2. I think in this day-- you can have both the comfort of home and the safety of a hospital. These are great points ladies!

  6. Kim, thanks so much for your insight. I agree
    it's the "what ifs" that get me. In my opinion,
    it's just not worth the risk. You're right in
    pointing out that a mother may not know she
    or her baby is in trouble. I'm happy to have
    provided some helpful statistics.

    Carol, I'm so glad delivering in a hospital
    has come such a long way! No longer do we
    shave and force enemas, but strive to make
    the process as comfortable and therapeutic
    as possible providing medical stability. Thank

    I'd also like to add that doulas are welcome
    in the hospital setting, a great way to ensure
    the laboring mother is being heard by her
    significant other and medical staff. :)

  7. Tanya, Thanks so much for this valuable and thought provoking post. Great information and insight from you and our expert commenters.

    1. Your welcome, Jordyn. Thank you for the opportunity. This topic is near and
      dear to my heart.

      I can't wait for your new novel to come out in June!

    2. Me, too. It is a little like having my own baby again-- without the pain, and pushing, and breast feeding (oh, and weight gain!).

      Though my two beautiful daughters were worth it.