The business of being born at home
Taking birth certificate data from the U.S. Centers for Disease Control and Prevention database, Grunebaum and his research team looked at more than 140,000 home births, about one-third of which were done without professional medical supervision.
While no distinction was made between intentional home births and women who simply didn't arrive at the hospital in time, Grunebaum is concerned at what he deems to be a trend. "There are women who have seen a movie about ten years ago calledThe Business of Being Born, and they feel they want a different experience compared to the hospital," Grunebaum toldFit Pregnancy.
While the documentary doesn't focus on home births that are unsupervised, it's part of a larger movement towards having babies outside of hospital settings, and one that seems to be gaining in popularity only in the U.S., according to Grunebaum, who notes that home births are declining in all other industrialized countries.
"To take care of a mother and a newborn baby takes a village," he says. "It takes people who are well trained. It takes a team that is dedicated to take care of mom and baby. It takes equipment and close supervision in order to identify complications, and it takes interventions to save lives."
There are many things that could go wrong with birth: ruptured membranes, an unexpected breech baby, placental abruption, the list goes on. What's important is that women are routinely screened for risks so that if an issue does arrive intervention can be done quickly. But no matter how close your home may be to the hospital, it can take many steps and precious minutes to get need the help needed. "We just had an emergency where we got the baby out in seven minutes," Grunebaum recalls. "If it took two or three more minutes, the outcome would not have been good."
The American College of Obstetricians and Gynecologists (ACOG) agrees that hospital and birthing center births are the safer option. So how can leery soon-to-be-mothers make themselves more comfortable within a clinical setting? Grunebaum says women should speak up to their doctors and let them know if they want fewer interventions, such as fetal monitoring. They should ask questions, let their wishes be known, and demand informed consent.
A safer home birth
For those who still intend to do labor and delivery at home, ACOG has provided some useful guidelines to help women make medically informed decisions and increase their chances of a safe experience.
Make sure you're a good candidate for home birth.This includes being pregnant with one fetus (not multiples), a gestational age between 36 and 41 weeks, a cephalic presentation (i.e. the baby is head-down), and no preexisting maternal disease or significant disease during pregnancy. ACOG does not recommend that women hoping to achieve a vaginal birth after a prior C-section do so at home.
Hire a certified nurse-midwife or certified midwife (by the American Midwifery Certification Board), or a physician who practices with a regulated health system.Make sure you have easy access to consultation whenever desired. And arrange a way to quickly and safely get to a nearby hospital in case of emergency.
While he doesn't tell anyone she's forbidden to give birth at home, Grunebaum wants expectant mothers to think of the issue in terms of managing risk: The chances of a baby dying in a car accident is 1 in 50,000; the risk of that baby dying in a home birth is 1-2 in 1,000.
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