Exactly what factors undoubtedly impact the safety of OOH birth?
- Consistently reliable educational standards and training; ie AMCB certified midwives.
- A defined scope of practice (including consistently valued, research-based assessments, and risking out criteria to ensure only truly low-risk pregnancies are taking place OOH).
- Midwifery practices that function within a fully integrated model of maternity care, for smooth consultation, collaboration, and transfer of care.
So what do the national and international maternity organizations have to say about home birth?
ACOG Planned Home Births
- "Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery."
- "Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth."
- "Importantly, women should be informed that the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife, or physician practicing within an integrated and regulated health system; ready access to consultation; and assurance of safe and timely transport to nearby hospitals are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes."
- "The recognition and regulation of certified professional midwives and lay midwives varies tremendously from state to state. At this time, for quality and safety reasons, the American College of Obstetricians and Gynecologists does not support the provision of care by lay midwives or other midwives who are not certified by the American Midwifery Certification Board."
AAP's Recommendations for Planned Home Births
- "The AAP concurs with the recent statement from the American College of Obstetricians and Gynecologists (ACOG) that the safest setting for a child’s birth is a hospital or birthing center, but recognizes that women and their families may desire a home birth for a variety of reasons."
- "Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board."
- "There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant. All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored."
- "A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.
ACNM Position Statement on Planned Home Birth
- "Every woman has a right to an informed choice regarding place of birth and access to safe home birth services.
- Certified nurse-midwives (CNMs) and certified midwives (CMs) (ie. AMCB certified midwives) are maternity care professionals who are qualified to provide ongoing assessment of appropriate birth site selection over the course of the antepartum, intrapartum and postpartum periods.
- CNMs and CMs (Again...AMCB certified midwives) are qualified to provide antepartum, intrapartum, postpartum and newborn care in the home.
- An integrated system of health care that includes collaboration among all health care providers is essential and fundamental to supporting a safe, seamless, transfer of care from home and/or out of the hospital setting when necessary.
- Reimbursement from third party payers should be available to licensed maternity care providers for home birth services.
- Professional liability insurance carriers should provide coverage at actuarially appropriate premiums for all licensed maternity care providers who attend home births.
- The characteristics and management of normal birth, including the influence of birth setting, should be the focus of research and evaluation. This research should address outcomes, client satisfaction and experience, markers of morbidity as they relate to birth site, and development of ongoing quality assurance initiatives."
In Summary, guidelines, recommendations, and the way in which out of hospital birth is approached matters a great deal in terms of safety. We won't preach "do your homework mama", because the vague message doesn't give any tangible guidelines for practice, nor does it help mothers know what to look for. We will however, highlight (as we've done here) the specific elements that contribute to the safety of out of hospital safety (or lack thereof) in an effort to help women better understand what to look for if they are considering home birth or a birth center birth. The absence of any one of the above named elements dramatically influences the safety of you and your baby.
Other opinions on the topic:
Navelgazing Midwife: AAP's New Homebirth Guidelines
Skeptical OB: MANA's Response to AAP's Guidelines
Science & Sensibility: MANA's Response to AAP Guidelines
(by Michigan's own Geradine Simkins, CNM, MSN, and director of MANA...posted here in the "opinion" section because this piece is so misleading it deserves it's own blog post rebuttal...coming soon.)