THE BENEFITS OF HOME BIRTH

Families opt for home births for a wide variety of reasons. Here are a few of the benefits associated with community birth:

• 1. Giving birth in a setting that is both familiar and comfortable.

  While this easily sounds warm and fuzzy on the surface, there are deeper implications and benefits when it comes to birth. From a physiological standpoint, we generally birth most easily when we feel safe and surrounded by the familiar. Bright lights, strangers coming in and out of our space, strange smells, etc can all trigger adrenaline release, which tends to stall or stop birth. Think about it, if our bodies read our surroundings as stressful and/or triggering a fight or flight response, then as a biologically protective measure, labor stalls to allow us to get to safer ground.

• 2. Less unnecessary interventions.

  Recommended interventions are proposed based on need and on an individual basis rather than generalized policy or to speed the birth process. All interventions include informed choice discussions that regard the birthing person as the key decision maker in their care. Minimizing unnecessary interventions also decreases the risk of the cascade of complications that can arise from routine use of unnecessary intervention.

  https://www.thelancet.com/.../PIIS2589-5370(20.../fulltext

• 3. Individualized care.

  Recommendations and care are based on you and your baby specifically and you are in the drivers seat. Hospital systems host thousands of births per year and typically have broad, sweeping policies to help things run more smoothly. In the home birth setting, families are able to be more than a number. This individualized care combined with continuity of care mentioned in a later point, make for overall best care for each family and their unique prenatal and intrapartum picture.

• 4. Higher rate of vaginal birth.

  For planned home births, there is a much higher rate of vaginal births and much lower rate of cesarean births (3.7 - 5.2%). These statistics include planned home births resulting in transfer for cesarean section.

  - Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18;330(7505):1416. doi: 10.1136/bmj.330.7505.1416. PMID: 15961814; PMCID: PMC558373.

  - Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D. and Vedam, S. (2014), Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women's Health, 59: 17-27. https://doi.org/10.1111/jmwh.12172

• 5. Rest and recovery in your own home.

  This includes access to your own foods and any desired cultural practices/norms. Uninterrupted boding with baby and everyone able to take a "big postpartum nap" after everyone is stable and taken care of (usually at 4-6 hrs after birth). If families wish for older siblings to meet baby and/or be a part of immediate postpartum, they are able to be there as well. Families opting for newborn procedures such as the vit k shot and/or erythromycin eye ointment are able to have procedures done with baby in arms.

• 6. Increased sleep during immediate postpartum as care is consolidated and comes to you.

  If you've ever recovered from a hospital birth, you know that it is not the most restful of recoveries. The nursing staff has to come in regularly for vitals on both mom and baby, then lab may need to come do blood work, peds needs to come see baby, then the newborn metabolic and hearing screens, and sometimes various other things throughout the stay. It doesn't leave much time for consecutive sleep, especially when you throw in a newborn who is nursing frequently to help bring milk in! With a home birth, all immediate postpartum procedures are completed at home and then, once everyone is stable, the birth space is tidied, and warning signs/when to page has been reviewed, the birth team departs. Your provider returns at 24 hrs postpartum to offer newborn screenings, check maternal and baby vitals, and provide any other needed care. Depending on the practice, normal newborn care is provided for the first 2 wks postpartum, alongside maternal postpartum care. All of this means significantly increased sleep, rest, and recovery.

• 7. Continuity of care

  One-on-one care (or in some multi-midwife practices, 2-4 midwives:1 client) prenatal, birth, and postpartum care. You know who will be at your birth and they have been providing care throughout your pregnancy. Your midwife is intimately familiar with your desires for your birth and postpartum, any previous birth trauma clients may have, and any unique best care indicated by a particular family's picture. Most community midwives highly value the importance of continuity of care and will transfer into the hospital as support should transfer become indicated or in the ambulance should transfer be emergent. Continuity of care has been shown to improve both outcomes and maternal satisfaction.

  - Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5. Accessed 13 March 2023.

  - Perriman N, Davis DL, Ferguson S. What women value in the midwifery continuity of care model: A systematic review with meta-synthesis. Midwifery. 2018 Jul;62:220-229. doi: 10.1016/j.midw.2018.04.011. Epub 2018 Apr 12. PMID: 29723790.

  - Fernandez Turienzo, C, Rayment-Jones, H, Roe, Y, et al. A realist review to explore how midwifery continuity of care may influence preterm birth in pregnant women. Birth. 2021; 48: 375– 388. https://doi.org/10.1111/birt.12547

• 8. Unlimited skin-to-skin and delayed cord clamping.

  All normal newborn care is routinely offered with baby in arms and skin to skin with mom in the home birth setting. There is so much happening during this time: temperature regulation, transition from getting oxygen through the umbilical cord to getting oxygen via the lungs, breastfeeding initiation, the list goes on. All of these are best facilitated with baby skin-to-skin with cord intact. If the birth team needs to offer positive pressure ventilation or any other resuscitative measures for baby, still receiving some oxygen through the cord is supportive of these measures. While hospitals are steadily responding to the research and consumer demand surrounding physiologically normal cord clamping, the majority are only willing to entertain a max of 1 minute of delayed cord clamping following birth. While this is a much needed improvement, in most cases it is a far cry from physiologically normal, where baby receives their full blood stores from their cord and placenta (for more info, see "wait for white" when researching delayed or physiological cord clamping).

• 9. High rates of breastfeeding success.

  Most midwives offer evaluation of baby's palate and tongue mobility for nursing alongside lactation support throughout the postpartum period. In my practice in particular, I enjoy teaching families about using their baby's reflexes for breastfeeding success, which is largely what their reflexes exist for. Home birth stats boast 91.5% exclusively breastfeeding at 1 week postpartum, 86-93% exclusively breastfeeding at 6 weeks postpartum (depending on the study), and increased rates of exclusive breastfeeding at 6 months postpartum.

  - Quigley C, Taut C, Zigman T, et al Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother–infant pairs from Ireland and the UK BMJ Open 2016;6:e010551. doi: 10.1136/bmjopen-2015-010551

  - Nethery E, Schummers L, Levine A, Caughey AB, Souter V, Gordon W. Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State. Obstet Gynecol. 2021 Nov 1;138(5):693-702. doi: 10.1097/AOG.0000000000004578. PMID: 34619716; PMCID: PMC8522628.

• 10. Increased convenience with history of fast births.

  For those with a history of birthing quickly, giving birth at home can increase the likelihood of birthing with a care provider in attendance versus birthing unattended and/or en route to the hospital. Midwives are additionally more likely to listen to their client's perception of impending birth instead of arbitrary birthing patterns, which makes them more likely to take seriously a client who is experiencing a precipitous birth.

• 11. For planned home birth, decreased maternal morbidity rates, maternal & perinatal mortality rates equivalent to that of hospital birth.

  Studies consistently indicate decreased maternal morbidity and equivalent maternal mortality rates for home birth with a certified midwife in attendance. Perinatal mortality research varies more widely, with research out of regions with more well-integrated midwifery care showing no statistically significant difference in perinatal mortality rates between planned home birth and planned hospital birth. With much conflicting research surrounding perinatal mortality rates, it is important to note the quality of the study (does it control for planned home birth vs unintended home birth, does it control for a certified/trained birth attendant, etc).

  - Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth. 2009 Sep;36(3):180-9. doi: 10.1111/j.1523-536X.2009.00322.x. PMID: 19747264.

  - de Jonge A, Geerts CC, van der Goes BY, Mol BW, Buitendijk SE, Nijhuis JG. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases. BJOG. 2015 Apr;122(5):720-8. doi: 10.1111/1471-0528.13084. Epub 2014 Sep 10. PMID: 25204886.

  - Reitsma A, Simioni J, Brunton G, Kaufman K, Hutton EK. Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine. 2020 Apr; 21: 100319. DOI:https://doi.org/10.1016/j.eclinm.2020.100319

  - Zielinski R, Ackerson K, Kane Low L. Planned home birth: benefits, risks, and opportunities. Int J Womens Health. 2015 Apr 8;7:361-77. doi: 10.2147/IJWH.S55561. PMID: 25914559; PMCID: PMC4399594.