Women who are interested in a planned home birth are entitled to make medically informed decisions about where to deliver their babies, according to an updated policy statement from the American College of Obstetricians and Gynecologists.
But women should know the risks and benefits of home birth based on the latest evidence. Although planned home birth is associated with fewer maternal interventions than planned hospital birth, there is also a twofold increased risk of perinatal death (1-2 per 1,000 births) and a threefold increased risk of neonatal seizures or other neurologic problems (0.4-0.6 per 1,000 births), according to the statement from ACOG’s Committee on Obstetric Practice, which updates its 2011 policy (Obstet Gynecol. 2016;128:e26-31).
ACOG maintains that hospitals and accredited birth centers are the safest settings for birth, and that unplanned home births are associated with increased rates of perinatal and neonatal mortality. “The relative risk versus benefit of a planned home birth, however, remains the subject of debate,” the committee wrote.
Women considering home birth should attend to several factors to help promote a safe delivery, including being a suitable candidate for home birth; identifying a qualified nurse-midwife, a qualified midwife, or a physician practicing obstetrics who is available for consultation; and preparing for safe, timely transport to a hospital if necessary.
An arrangement with a hospital for transfer is a requirement for women considering a planned home birth, according to the statement. However, the statement advised the hospital and health care team to refrain from judgment should their help be needed.
“When antepartum, intrapartum, or postpartum transfer of a woman from home to a hospital occurs, the receiving health care provider should maintain a nonjudgmental demeanor with regard to the woman and those individuals accompanying her to the hospital,” the committee wrote.
Although the current statement supports a woman’s right to make a medically informed decision, it emphasizes that any of several factors including fetal malpresentation, multiple gestation, and prior cesarean delivery are “an absolute contraindication to planned home birth.”