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At-home birth has pros and cons

The number of at-home births is small but growing as pregnant women weigh the idea of a drug-free and surgery-free birth in a familiar setting versus the risk of harm to the baby in case of complications.

July 11, 2011|By Olga Khazan, Special to the Los Angeles Times
  • Often birthing tubs are used for at-home deliveries.
Often birthing tubs are used for at-home deliveries. (Frank Herholdt, Getty Images )

When most pregnant women go into labor, they pack their bags for the hospital. When Lara Carlos felt the contractions in November 2008, she set up a birthing tub in her bedroom.

For the next several hours, Carlos alternated between padding around her home and squatting and pushing in the tub. Her midwife poured water down her back and dabbed her forehead with cold towels. When the baby (they chose the name Vincent) arrived at 1:21 a.m., he spent his first few hours cuddling with his parents in their bed.

Carlos, who lives in Redlands, is one of a small but growing number of women who are choosing to deliver their babies at home. Her first son, Ivan, had been delivered in a hospital, and she says she found labor at home a dramatic improvement.

"In the hospital, there were seven medical students in the room when I was pushing my son out," she said. "At home, it was a very quiet, slow experience, and the water helped me to relax."

Though home births account for only about 1% of all births each year — 28,400 annually — they increased by 20% from 2004 to 2008 (the most recent available data), according to a May study in the journal Birth: Issues in Perinatal Care. The practice is most popular among well-educated mothers who favor natural childbirth without the drugs or surgeries a hospital might use.

"Women want to be able to say, 'I didn't think I could do it, but I did it for my baby,'" Carlos says. "They walk away feeling amazing, knowing that nobody did it but them."

The increase has reenergized the fierce debate over the safety of at-home delivery. The practice is officially frowned on by the American College of Obstetricians and Gynecologists, which issued an opinion in January saying it discourages home births because the absence of emergency medical equipment and specialists accustomed to dealing with complications means that problems during labor could cost the baby's life.

"All the existing scientific evidence, as well as state and national statistics, make it ultra-clear that home birth increases the risk of death," says Dr. Amy Tuteur, a Boston-based physician and former clinical instructor in obstetrics at Harvard Medical School who opposes home births. "What I had seen of it during my years of practice were only disasters."

The American College of Obstetricians and Gynecologists does acknowledge that home births are associated with fewer medical interventions than hospital births — a huge selling point for home-birth moms who want to experience a "natural" birth and avoid frequently administered drugs, such as Pitocin, which strengthens uterine contractions, and epidurals, which relieve pain when injected into the spinal canal. According to an April report by the Centers for Disease Control and Prevention, 61% of women who had vaginal delivery received an epidural in 2008, the year the report studied. And a 2006 national survey of women's childbearing experiences showed that 55% were given Pitocin to speed labor.

"There's no doubt that once you end up in a hospital, you end up with more interventions — that's what drives some families away," says Dr. Joseph Ouzounian, chief of obstetrics at Los Angeles County-USC Medical Center, who believes home birth is reasonable as long as women have few risk factors (such as health issues or being older than 35), have an emergency backup plan and understand the risks involved.

Women also turn to home birth in order to avoid caesarean sections, which have become more common as obstetricians became increasingly reluctant to take chances at the slightest sign of fetal distress. According to the CDC, caesareans now account for nearly one-third of hospital births in the United States — a much higher rate than most doctors say is ideal.

What's more, many hospitals do not allow women who have previously had a caesarean to attempt a vaginal birth because of the risk of uterine rupture, even though a 2010 National Institutes of Health advisory panel concluded that the risk of uterine rupture during a vaginal birth after one caesarean was just 1% and that more women should be offered the choice. Women wishing to have a VBAC (vaginal birth after caesarean) may have no option but to do so on their own turf.

Sarah Bolson of Covina had two caesareans but chose a home birth for her third pregnancy, successfully delivering a baby girl in January 2010.

"We had visited numerous hospitals, and the first time I mentioned a VBAC, I was just shut down completely," Bolson says. Doctors refused to consider it because of the chance of rupture, she recalls, and one said he couldn't risk having his medical malpractice insurance skyrocket.

She eventually found a certified professional midwife who was willing to help her deliver at home, with a backup plan of transfer to a nearby hospital. Though initially worried about complications, "after I was able to release the fear, I was free to birth without any inhibition."

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