With a focus on COVID-19 safety, most hospitals have limited the amount of support allowed in the delivery room, mandated induction of labor, and isolated babies from parents that show symptoms of the virus. This has pushed many people to reconsider their birth plans. Midwives and doulas guide women through pregnancies and deliveries at home. These specialists have seen an uptick in demand for their services during the pandemic as more women are shying away from hospital deliveries and opting for home births. While the American College of Obstetricians and Gynecologists recommends hospitals and accredited birth centers as the safest environments to give birth, everyone has the right to make informed decisions about their birth plan. If you’re considering a home birth, here’s what you need to know.
Benefits of a Home Birth
Under the best circumstances, a home birth offers a more comfortable birthing experience for both parent and child. But this option is appealing for a number of other reasons. Research has shown that home births involve fewer interventions like cesarean delivery, operative vaginal delivery, labor induction or augmentation, regional analgesia, episiotomy, and electronic fetal heart rate monitoring. They also involve fewer major perineal tears. There is also evidence that low-risk pregnant people giving birth at home aren’t more likely to develop complications than they would at a hospital. But some people are better candidates for home births than others. Kimberly Langdon, MD and retired OB-GYN, recommends home birth as a safe option for people who have experienced at least one vaginal birth without needing an epidural and without complications like maternal diabetes or high blood pressure, shoulder dystocia, forceps or vacuum delivery, or postpartum hemorrhage. In her career as a nurse practitioner with a specialty in midwifery, Fadwah Halaby, APRN, CNM, has assisted in more than 1,600 births. As a home birth advocate, she practices what she preaches: She delivered her six children at home. Halaby’s midwifery practice in Florida, Midwife 360, has seen business triple amid the pandemic. But she points out that people have been birthing their children at home since the beginning of time, and only the past 100 years or so has it been common practice to give birth in a hospital. “It doesn’t make sense that natural, healthy, low-risk births take place in the hospital in the first place," Halaby says. “It’s so natural to our bodies… and if you’re healthy and low-risk and your mind is in the right place, then it’s a very natural choice.”
Understanding the Risks
There are risks associated specifically with home births. Research from ACOG says the risk of stillbirths and infant deaths within the first month of life doubles when a baby is delivered at home. The risk of neonatal seizures triples. “The biggest risk is that there is fetal distress that does not resolve, and an emergency Cesarean section must be done,” Langdon says. It’s possible that unanticipated complications will arise during a home birth that would require transfer to a hospital. For this reason, it’s recommended that giving birth within 15 minutes of a hospital is key for the safety of both parent and child.
Home Birth Accessibility
It’s important to note that the increase in home births during the pandemic has been mainly among non-Hispanic White women, according to the American Academy of Pediatrics. Black communities, which are disproportionately affected by COVID-19, are often left behind when it comes to adequate medical care, in general. The same is true for pregnant people. In fact, in the U.S., pregnancy-related deaths (death of the mother during childbirth or in the following year), affect Black women three times as often as White women. Inequity within the health care system and a failure to listen to the needs of Black individuals has fostered a lack of trust in these systems. However, whereas a home birth could be a viable option for women who aren’t eager to give birth in a hospital, access to home birth care for Black women is more limited. All pregnant people deserve the same care and attention necessary for a safe birth. This requires a deep examination of discriminatory policies and gatekeeping within maternal health care.
Preparing for a Home Birth
If a home birth feels right for you, it’s important to speak with your doctor or midwife well in advance to discuss potential risks and flesh out your birth plan. Halaby recommends hiring a doula in any birthing scenario. “Every woman deserves a doula, especially with home births,” she says. “Doulas are very helpful to the client and to the midwife.” Consulting with a potential doula early on is crucial to determine whether they’re a good fit for you and your birth plan. This introduction can provide important details on a doula’s level of experience. Ask questions about their transfer rate and what kinds of instances they’ve transferred to a hospital, as well as what backup arrangements looks like. With a home birth, having a backup plan is absolutely necessary. Developing this with your providers will help prevent future surprises, provide peace of mind and optimize a safe and healthy delivery of your child. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
