The U.K.’s National Health Service shifts its recommendation, but U.S. organizations are still split on home birth support.
Giving birth at home will become the norm in the United Kingdom if the country’s National Health Service has its way. The NHS says home birth is “just as safe” as a hospital birth for second-time moms and as safe as a “small midwife-led unit” for first-time mothers. Why the change, and is the United States going to follow suit?
The sudden shift in the NHS’s recommendation may stem from the conditions in the obstetrics wards of British hospitals. In May, David Richmond, president of the Royal College of Obstetricians and Gynecologists, said that up to 300 babies a year are dying because of to NHS staff shortages. Union leaders have told NHS that they need 5,000 additional midwives to ensure proper standards of care.
In 2011, according to Britain’s Office for National Statistics, 2.4 percent of women in England and Wales gave birth at home, which is down from 2.5 percent in 2010. In the United States, home birth is an option that is used less often, but the rates have increased in the past few years. The CDC reports that the rate of out-of-hospital births in the United States increased from 1.26 percent in 2011 to 1.36 percent in 2012. Between 2004 and 2008, U.S. home births rose by 20 percent.
In 2010, The American Journal of Obstetrics and Gynecology issued a report that said rates of newborn deaths were two to three times as high for planned home births compared with planned hospital births. The blowback from the report was so severe that the journal ordered independent reviews of the conclusions. It stuck to the original findings. Time magazinequestions whether statistics will always be second-guessed because the numbers from both sides rarely tell the whole story. For now, having a baby at a hospital or birthing center with a midwife seems to be the safest option.
The World Health Organization, the American College of Nurse Midwives, the American Public Health Association, and the National Perinatal Association all support home and out-of-hospital births for low-risk women. Women who choose to have their babies at home are usually college educated and in their 30s and 40s with at least one child already. They often cite the desire to have some kind of control over their births and want to avoid cesarean sections.
Robert Atlas, chairman of the Department of Obstetrics and Gynecology at Mercy Medical Center in Baltimore, acknowledges that it’s a difficult subject for doctors to comment on.
“We have seen ‘low-risk’ pregnancies go quite wrong. What worries me about home births is that most do go OK; however, if there is an issue, it can go very wrong with significant injury to potentially both mother an child,” he says. “But many countries [such as the Netherlands] have 30 percent of births occurring at home, and there have been very good outcomes.”
Atlas is a big supporter of midwifery, but he is concerned about training.
“OB-GYNs have to do a minimum of over 200 vaginal deliveries and at least 150 C-sections before we graduate from our training,” Atlas says. “There can be lay midwives who have attended only a few to up to 10 [births] before they can attend a delivery.”
Many modern hospital birthing centers, such as Mercy’s Family Childbirth and Children’s Center in Baltimore, offer home-like environments with certified nurse midwifes to attend births, so if something goes wrong, there are doctors nearby who are equipped to help.