Home births growing in popularity - AmericaNowNews.com

Home births more popular

A growing number of parents are turning their bedrooms into delivery rooms.

According to the Centers for Disease Control and Prevention, home births have increased by nearly 30 percent over the past few years. Moms, midwives and doctors predict the popularity of home births will continue to increase.

America Now was in Ali Corral's bedroom when she delivered her 8-pound, 10-ounce daughter with the only equipment she deemed essential -- her body, husband and two midwives, as well as a few basic medical tools and her own sheer will.

Denver Corral's arrival added yet another birth to the growing trend in home births across the country, a trend that is hardly surprising to hospitals.

"I think its probably risen more," says Dr. Frank Harrison, who is with the Department of Obstetrics and Gynecology at Carolinas Medical Center in Charlotte, North Carolina.

One reason for the popularity of home births is because giving birth to a child in a hospital setting is expensive.

For their first daughter, the Corrals didn't have maternity insurance with their private health plan.

Out-of-pocket, a hospital birth without any complications or a Caesarean section (C-section) will likely cost at least $10,000 compared to $1,000 to $4,000 for a home birth or a delivery at a birthing center.

Besides the cost, the Corrals say they would still choose the midwife model of care because it offers a personal relationship with a midwife who encourages the use of minimal medical and technological intervention like an epidural or Caesarean section.

"She believes and we believe as a family that it was for the good of her and for the good of our baby to do it completely naturally, and we have three completely healthy kids," husband Mark Corral says.

Based on an analysis of several studies, the American College of Obstetricians and Gynecologists has acknowledged that while planned home births were associated with fewer medical interventions, lacerations and infections, evidence suggests the risk of neonatal death increases two-fold in planned home births as compared to planned hospital births.

Wary of complications that might arise during labor, obstetricians stand by the safety net provided by a hospital delivery.

"If you ignore the technology, you're going to lose some babies," Dr. Harrison warns.

However, many moms choose a home birth to avoid that technology, specifically, Caesarean sections which now account for more than 32 percent of births according to the Centers for Disease Control and Prevention. 

"Unfortunately, in this country, the safest route equals C-section," Ali Corral says.

She wanted her birth to be a family event and not a medical one. To ensure a safe home birth, she did her homework before choosing a midwife.

She interviewed several about their training, experience, references, health insurance policy, emergency back-up plan and hospital transfer rate.

Lisa Johnson is a licensed midwife at Carolinas Community Maternity Center.

"I know when to evaluate when something is beyond my scope of care," Johnson says. "When something is beyond what I'm able to handle, I'm able to assess and make that decision that it's time to go to the hospital."

She was licensed in South Carolina after achieving a level of midwifery schooling and apprenticeship.

Parents need to know the laws in their state, because some home births are prohibited unless attended by a certified nurse midwife who is licensed in both nursing and midwifery.

If you decide there's no place like home, carefully consider the risks along with the personal rewards for you and your baby.

After all, this is the most important birthday you will plan for them.

If you decide on a hospital delivery, don't be afraid to check out your doctor, too. Ask about their C-section rate and experience if you're concerned.

Whether it's an obstetrician or a midwife, inquire about their medical malpractice insurance. Rising rates are pushing many obstetricians out of business, and not all midwives carry it.

Additional Information: 

- The following information is from Dr. Frank Harrison, Department of Obstetrics and Gynecology at Carolinas Medical Center in Charlotte, NC. His personal suggestion for moms looking for an alternative is working with a Certified nurse midwife in a hospital or affiliated birth center. Certified nurse midwifes have the back-up of a physician. He says an acceptable transfer rate for a midwife is between 8 and 10 percent.

- The following information is from Mark and Ali Corral. Their oldest daughter, Bella, was born in a birth center. Their second daughter, Joanna, was born at home. Ali preferred the personal relationship she had with her midwife, including the ability to call and email her, etc. Mark says the midwives are more like coaches for both mom and dad throughout the entire duration of the pregnancy.

- The following information is from Lisa Johnson, a licensed midwife at Carolinas Community Maternity Center. Her concern is with the continuity of care in a hospital setting. Parents may see multiple OB's and nurses throughout the pregnancy which defeats an individualized care plan. The Carolina Community Maternity Center was established after strong community demand. The facility is able to monitor the baby's heart rate during delivery, the mother's vial signs, administer oxygen and anti-hemorrhage medication and they are trained in neonatal resuscitation. The facility will transfer a mother into doctor care if during neonatal they develop health issues. They will not perform breach births or multiple gestations (twins). Their midwives are registered with the State Board of Health.

- This chart shows a cost comparison, hospital vs home: http://transform.childbirthconnection.org/resources/datacenter/chargeschart/

- The following definitions are from www.mana.org

1. Certified midwives (C.M.) meet American College of Nurse-Midwives (midwife.org) requirements, but they do not need to be nurses.

2. Certified nurse-midwives (C.N.M.) are nurse- practitioners who are certified by the American College of Nurse-Midwives.

3. Certified professional midwives (C.P.M.) meet North American Registry of Midwives (narm.org) certification standards.

4. Direct entry midwives (D.E.M.) are educated through self-study, apprenticeship, midwifery school or college- or university-based programs that don't include nursing. They include certified midwives and certified professional midwives.

5. Lay midwives are sometimes called traditional, unlicensed or "granny" midwives. These women are educated through self-study and apprenticeships, and while they may be highly experienced and skilled, they aren't certified or licensed.

6. Licensed midwives (L.M.) can practice in a particular jurisdiction, usually a state or province.

- The following statistics are from the Centers for Disease Control and Prevention (Click here for more details.) Births taking place at home rose nearly 30% between 2004 and 2009, and an estimated 90% of these are planned. A breakdown of who helps women give birth at home: 42.9% (Certified professional, direct-entry or other midwives), 32.9% (Relatives, emergency medical technicians, other), 19.5% (Certified nurse midwives), and 4.8% (Physicians).

- After declining from 1990 to 2004, the percentage of U.S. births that occurred at home jumped 29 percent from 2004 to 2009, when it hit the highest level since researchers began collecting data 20 years earlier. (http://vitals.msnbc.msn.com/_news/2012/01/26/10242611-home-births-rise-nearly-30-percent)

- Non-Hispanic white women were most likely to give birth at home in 2009, with one in every 90 births, or about 1.1 percent, in that group taking place at home. That represents an increase of 36 percent over 2004.

- Home births more common among women 35 and older and among women with several previous children. (Source: CDC)

- According to the ACOG, although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth. When infants with congenital defects were excluded, the risk of neonatal mortality tripled. (Source: CDC)

- ACOG Committee Opinion: Believes that hospitals and birthing centers are the safest setting for birth, but respects the right of a woman to make a medically informed decision about delivery. Although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth. The appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife, or physician practicing within an integrated and regulated health system; ready access to consultation; and assurance of safe and timely transport to nearby hospitals are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. In the United States, approximately 25,000 births (0.6%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended and without provisions for professional care during childbirth, are subsequently associated with high rates of perinatal and neonatal mortality. To date there have been no adequate randomized clinical trials of planned home birth. Click here to read more about the ACOG Committee Opinion.

- Pregnant women have been reluctant to participate in clinical trials involving randomization to home or hospital birth (i.e. being "instructed" where to deliver for the purpose of a study).

- Consequently, most information on planned home births comes from observational studies and are limited by small sample sizes, lack of control group, reliance on birth certificate data, voluntary submission and self-reporting, variation in skill and training of the birth attendant, among other factors.

- Based on a meta-analysis (results of several studies) of observational studies, although perinatal (before birth) mortality rates were similar among planned home births and planned hospital births, planned home births were associated with a twofold-increased risk of neonatal death (after birth).

- When limited to only nonanomalous newborns, the increased risk of neonatal death was even higher, almost threefold higher in planned home births.

- No maternal deaths were reported among 10,977 planned home births.

- When compared with planned hospital births, planned home births are associated with fewer maternal interventions (epidural, electronic fetal heart rate monitoring, episiotomy (cutting the skin between the vagina and anus), operative vaginal delivery (forceps or vacuum), and Caesarean delivery.                                 

- Planned home births are associated with fewer third-degree lacerations or fourth-degree lacerations, less maternal infection and similar rates of postpartum hemorrhage, perineal laceration, vaginal laceration, and umbilical cord prolapse.

- Rates of pre-term birth before 37 weeks of gestation and low birth weight were lower for planned home birth, likely because of selection bias.

- The reported risk of needing an intrapartum transport to a hospital is 25–37% for 1st-time mothers and 4–9% for women who had already given birth before, due to lack of progress, fetal status, pain relief, hypertension, bleeding and fetal position.

- Planned home births can be safe only when involving healthy pregnant women (no preexisting maternal disease, no significant disease arising during the pregnancy, a singleton fetus, gestational age greater than 36 weeks and less than 41 completed weeks of pregnancy).

- American College of Obstetricians and Gynecologists recommends that labor after cesarean delivery be undertaken in facilities with staff immediately available to provide emergency care (27). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice considers a prior cesarean delivery to be an absolute contraindication to planned home birth.

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