MONDAY, April 29 (HealthDay News) -- With the number of home
births rising, the American Academy of Pediatrics has issued a
policy statement on the practice that includes a recommendation
that there be a caregiver who's present solely to take care of the
"Babies deserve the best care they can get," said Dr. Kristi Watterberg, lead author of the statement and a professor in the division of neonatology at the University of New Mexico. "And we need to support women wherever they choose to give birth."
There are a number of reasons women may choose to give birth at
home, according to background information in the statement. They
may wish for a more family-friendly setting, increased control of
the birthing process, fewer medical interventions and lower costs.
The rate of home births is still under 1 percent in the United
States, but it is growing, according to the policy statement.
A recent report from the U.S. Centers for Disease Control and
Prevention found that the number of home births jumped 20 percent
between 2004 and 2008. More than 28,000 babies were born at home in
2008, which was the highest number of home births since 1990.
Home births aren't well supported by the medical community.
Various state laws and regulations can make a home birth even
harder to achieve. There also may be a lack of well-trained and
willing caregivers, or support in case of an emergency. Geography
can also present a problem. Travel times greater than 20 minutes to
medical care have been linked to an increased risk of
complications, including death of the baby, according to the
Some studies have suggested that home births in the United
States are linked to a twofold to threefold higher risk of neonatal
death. But Watterberg said a study done in British Columbia, where
there's a more integrated system that supports mothers birthing at
home, found no increased risk of neonatal death. "We need better
research," said Watterberg.
However, because the rate of home births is increasing, and
because the academy wants to provide a "professional, supportive
interaction" with expectant mothers, Watterberg said the group
developed its new policy. The AAP recommends the following factors
for a mother considering a home delivery:
Watterberg said midwives often work in teams, and one can be
responsible for the baby's care after birth.
"It's important to remember that this is an area of strong emotion. You'll see babies in home births have terrible things happen, but you also have terrible things happen in the hospital sometimes. Women have the right to make an informed decision," she said.
And, if a woman chooses home birth, Watterberg said it's
important for the expectant mother to meet the person who will care
for her baby after birth. "Meet with that person beforehand. Talk
with them about your plans, and see if they have anything to add,"
Dr. Peter Bernstein is a maternal-fetal medicine specialist and
director of the perinatal safety program at Montefiore Medical
Center in New York City. He said: "A woman planning a home birth
has a lot of due diligence to take care of that she doesn't have to
worry about in the hospital, like making sure the correct equipment
is there, that the staffing is there and qualified.
"I understand where women are coming from. A hospital birth can become very medicalized and women feel a loss of control, but I'm nervous about home births. Too many simple things can turn into disasters at home. Even in low-risk women, things can go wrong. Then you may be 20 minutes from the hospital, and it's another 15 minutes once you get to the hospital before you can get the baby out in an emergency," explained Bernstein, who acknowledged that he treats high-risk pregnancies, so he tends to see more complicated births.
"I'd like to see a middle ground. I'd like to see more birthing centers associated with hospitals. Bring the home birth movement to a setting that feels more like home, but is attached to the hospital," he said.
But, he added, "In a low-risk woman, who can set it up properly,
home birth shouldn't be outlawed. A woman can have the choice to
have her baby at home."
The full policy statement is published online April 29 and will
appear in the May print issue of the journal
Learn more about home births from the
American College of Obstetricians and
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