Home birth
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Home birth is childbirth that occurs outside a hospital or birthing center setting, usually in the home of the mother. Most home births are assisted by midwives, but some home births are physician assisted. Others have no medical assistance at all. This is known as free-birth or unassisted home birth.
In most Western countries, home birth declined over the 20th century, although there was some revival of the practice in 1970s. In The Netherlands, about 30% of all births occur at home, but this number is falling. In countries where midwives are the main carers for pregnant women, home birth is more prevalent.
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Types of home birth
Assisted home birth
For low-risk pregnancies, a number of studies have shown that planned, assisted homebirths are at least as safe as hospital births. There are fewer medical interventions, such as cesarean sections, forceps deliveries, episiotomies and administration of pain medication such as epidurals, all of which pose some risk to the lives and health of the mother and baby. Antibiotic resistant pathogens commonly found in hospitals, such as staph (methicillin-resistant Staphylococcus aureus and others), are less likely to be transferred to the mother or child when the birth takes place at home. However, in the case of emergencies such as cord prolapse, breathing problems with the infant, or bleeding of the mother, there is less access to life-saving equipment, although properly trained midwives can manage such emergencies until the woman can be transferred to hospital.
Unassisted home birth
There have been no formal studies on unassisted birth. A mother having an unassisted home birth can do so in the environment in which she feels most comfortable.
Many mothers choose a "couple's birth" where the birthing mother and her spouse or partner are the only ones present while she gives birth. Other children may be sleeping, or busy elsewhere in the house. Advocates of unassisted birth believe that couple's birth is an intimate extension of babymaking.
Differing opinions
Proponents of home birth prefer the atmosphere of a home birth. The mother has more control over her surroundings, and can eat and move around, sleep and do anything she pleases – activities which may be prohibited in a hospital setting. The mother is often more comfortable in her own home and increased comfort contributes to shorter labor. The germs that colonize the baby's skin and gut are the normal germs of that family's home, to which the baby has immunity acquired from the mother.
Conversely, some mothers are more comfortable in a hospital setting because they implicitly trust the medical system and because they prefer to be closer to an operating room should an emergency arise, such as the need for a caesarean section, although as it usually takes a minimum of 30 minutes to prepare an operating theatre for surgery and so for women within easy travelling distance of a hospital, this is less important.
Safety
Over the years the safety of home birth has been questioned and designing randomized controlled trials to test the safety of home birth compared to hospital birth has significant ethical problems. Studies of safety have generally found home birth (for healthy women with uncomplicated pregnancies) is as safe as hospital birth. However, a recent study in the British Medical Journal Outcomes of planned home births with certified professional midwives: large prospective study in North America (Johnson & Davis, 2005), concluded that "medical intervention rates (such as epidural, episiotomy, forceps, ventouse, and caesarean section) were substantially lower than for low risk US women having hospital births.'" For example, amongst the home birth women, 3.7% ended up having a caesarean section compared to 19% for the US as a whole (for a similar risk profile) [2000 data].
Legal Situation
No matter where, one can simply have an unassisted childbirth. Many people, especially first-time mothers, would prefer to hire a midwife. This is currently difficult in some areas, although the situation is changing.
In the early and mid 1900s, physicians pushed to have midwifery banned throughout the United States. Childbirth became very clinical and controlling, with the mother generally subdued with leather straps and ether. Over recent decades, the situation has changed greatly. In 37 states it is once again legal to purchase the services of a midwife. Many midwives work in the other states in spite of the law, while efforts are underway to change the law.
The sale and/or purchase of midwife services is still (as of May 2005) illegal in Washington D.C. and the following 13 states: AL, GA, HI, IL, IN, IA, KY, MD, MO, NY, NC, RI, SD.
Additional Reading
The birthjunkie site (http://www.birthjunkie.com/homebirth/) has an unassisted childbirth forum (http://www.birthjunkie.com/active/bboard.mv) where you can discuss unassisted and minimally assisted childbirth with others. You can also read birth stories (http://www.birthjunkie.com/uc_stories.html) from unassisted births, including an 11.25 pound (5.1 kg) baby (http://www.birthjunkie.com/tracie.html) born without tearing.
The MANA state-by-state chart (http://www.mana.org/statechart.html) shows midwife certification requirements and reimbursement by Medicaid. It is common for private insurance to reimburse according to the Medicaid rules.
Jessica Mitford, "The American Way of Birth"
Summary of Medical Studies on Homebirth (http://www.changesurfer.com/Hlth/homebirth.html)
References
Kenneth C Johnson and Betty-Anne Daviss, Outcomes of planned home births with certified professional midwives in North America: large prospective study, BMJ 2005;330;1416