Labor and delivery, postpartum care

If you're considering a planned home birth, you probably have questions. Is it safe? Will you need a midwife or doula? How do you create a backup plan? Find out what's involved and what to consider as you decide if delivering your baby at home is right for you.

Why do some people choose planned home births?

The choice of a planned home birth may be appealing for a variety of reasons, including:

• A desire to give birth without medical interventions such as pain medication, labor induction, fetal heart rate monitoring, or delivery assisted with forceps or other instruments
• A desire to give birth in a comfortable, familiar place
• Dissatisfaction with hospital care
• A desire for more control of the birthing process
• Cultural or religious concerns
• Lack of access to transportation
• Lack of a local hospital
• Lower cost

Are there situations when a planned home birth isn't recommended?

The American College of Obstetricians and Gynecologists cautions against a planned home birth if:

• You are pregnant with more than one baby.
• Your baby doesn't settle into a position that allows for a headfirst delivery.
• You've had a C-section in the past.

What might cause the need to go to a hospital?

During a planned home birth, you might need to go to a hospital if problems develop during labor and delivery. Your health care provider might advise you go to a hospital if:

• Labor isn't progressing.
• Your baby shows signs of distress.
• Your baby is in a position other than headfirst.
• You need pain relief.
• You have high blood pressure.
• You experience bleeding.
• You develop a fever.

What are the possible risks of a planned home birth?

Most pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures and nervous system disorders than planned hospital births.

There are several factors that might reduce the risks of these problems, including having:

• Assistance from a certified nurse-midwife
• Access to a doctor who specializes in obstetrics
• A plan for transportation to a nearby hospital, if needed

It's important to talk to your health care provider before you make a decision about a planned home birth. For some people with certain health conditions, as well as those who have not given birth before, the risks of a planned home birth may be higher than they are for others.

How do I prepare for a home birth?

One of the most important steps in planning for a home birth is finding well-trained health care providers to assist you. It is common for a midwife to provide care during a home birth. If you choose a midwife, make sure that person is one of the following:

• A certified nurse-midwife
• A certified midwife
• A midwife whose education and license meets international standards

Although it is uncommon, in some areas, doctors who specialize in obstetrics may be available to assist with home births. Make sure the health care provider you choose has easy access to doctors or specialists at a nearby hospital.

The American Academy of Pediatrics also recommends having present at least one trained person whose primary responsibility is caring for your newborn.

If you're interested in having more help, consider hiring a professional labor assistant (doula).

Consider these questions:

• Who do you want to be with you when you give birth?
• What do you want your surroundings to be like?
• What comfort measures would you like to rely on during labor?
• Will you use any specific methods to manage pain?
• Do you want to breast-feed your baby immediately after delivery?

If you haven't done so before, consider taking a childbirth class to help you prepare, so you know what to expect during labor and delivery. Such a class also can give you time to talk with other expectant parents and come up with more questions or topics to consider for your birth plan.

Discuss your birth plan with your health care provider. Go over your expectations and make a list of the equipment and supplies you'll need to meet those expectations and ensure a safe experience for you and your baby. Share the plan with others who will be supporting you during labor and delivery. This will help everyone understand what you want, so you can feel safe, supported and confident in your birth experience.

Make the following preparations for a smooth transition to a hospital, if you need it:

• Discuss with your health care provider the symptoms that might mean you'll have to go to a hospital. Talk about how that fits into your birth plan.
• Make sure you have access to transportation. Ideally, your home or other birth location is within 15 minutes of a hospital with 24-hour maternity care.
• Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly moved to the hospital and treated, if necessary.

Hospitals or certified birth centers are the safest settings for delivery. However, you have the right to make an informed decision about where you prefer to deliver your baby. Keep in mind that life-threatening problems can occur during labor and delivery. In those cases, the need to take you and your baby to a hospital could delay care. That could put your lives at risk. Understand the risks and benefits of a home birth before you make a decision about where to deliver.

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