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Guidelines for Planned Home Birth

Obstet Gynecol; 2016 Aug; Committee on Obstetric Practice, et al

The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice has issued a Committee Opinion and recommends the following regarding planned home birth:

• Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than 2-fold increased risk of perinatal death (1 to 2 in 1,000) and a 3-fold increased risk of neonatal seizures or serious neurologic dysfunction (0.4 to 0.6 in 1,000). These observations may reflect fewer obstetric risk factors among women planning home birth compared with those planning hospital birth. Although the American College of Obstetricians and Gynecologists (the College) believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery.

• Women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals.

• The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.

Citation:

American College of Obstetricians and Gynecologists’ (the College) Committee on Obstetric Practice, et al. Planned home birth. Committee Opinion No. 669. Obstet Gynecol. 2016;128:26-31.