Home or hospital? The question of where to give birth is a topic of ongoing discussion among expectant moms, doctors, midwives, and home birth advocates. As the number of women who give birth at home increases, the sometimes heated debate about which is safer for women, babies, and families will surely continue. The author of a recent New York Times Magazine article wrote “It is unfortunate that the choices and the rhetoric around birth—like many of the choices and rhetoric around motherhood in general—are so polarized.” It’s a big decision.
A woman’s health and risk factors should be central considerations in deciding on a birth venue. Although studies have shown that absolute risks of planned home birth are low, home births don’t always go as planned. Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth. Risks also increase in women with certain medical conditions such as hypertension, breech presentation, or prior cesarean deliveries, or in births where there are inadequately trained attendants. It is important for any woman choosing home birth to have a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system with ready access to consultation and a plan for safe and quick transportation to a hospital in case of an emergency.
While ACOG believes that hospitals and birthing centers are the safest place for labor and delivery, we respect a woman’s right to make a medically informed decision about her birth experience. ACOG also continues to support collaborative practices between physicians and certified nurse-midwives/certified midwives to further improve outcomes for pregnant women and their babies.
Ultimately, women have a choice in where to give birth. As ob-gyns, it’s our job to educate our patients on the risks and benefits of hospital vs. home delivery and help them make the best decision for themselves and their families.