Pediatricians Weigh in on Home Birth

Home birth not as safe as hospital or birthing center

(RxWiki News) Home births in the US have been increasing, but how safe is it to have a baby at home? Do these children have less access to emergency care if needed. 

The American Academy of Pediatrics released a statement noting that the safest place to have a baby is in a hospital or birthing center.

Their policy statement also described the care that all newborn babies should receive, regardless of where they are born.

"Attend all prenatal appointments."

The policy statement written by the AAP's Committee on the Fetus and Newborn, led by Kristi L. Watterberg, MD.

"The American Academy of Pediatrics concurs with the recent statement of the American College of Obstetricians and Gynecologists [ACOG] affirming that hospitals and birthing centers are the safest settings for birth in the United States while respecting the right of women to make a medically informed decision about delivery," the policy states.

The statement noted that home births remained less than 1 percent of all births in the US, but the number has been increasing.

Even so, the infrastructure for safe home births often is lacking, and the AAP noted research showing that travel time of more than 20 minutes to an emergency center are linked to higher risks for poor outcomes, including newborn deaths.

Overall, the rate of newborn deaths is two to three times higher among home births than among hospital and birthing center births in the US. That rate equates to one additional newborn death for every 1,000 babies born at home.

If a woman is considering a home birth, the AAP said the following circumstances should be present to decrease risks:

  • The mother should not have had any diseases while pregnant
  • She should be pregnant with a single baby, not multiples, who is in the appropriate range for weight for the pregnancy week
  • The baby's head should be pointed down toward the cervix
  • The mother should be between 37 and 41 weeks of pregnancy
  • The mother should go into labor naturally or as a clinic outpatient
  • The mother should not have been referred from another hospital
  • A certified nurse midwife, certified midwife or doctor should be present who is associated with a local regulated healthcare system
  • At least 1 appropriately trained person should be present whose primary responsibility is to care for the newborn (in case the mother needs care and is unable to do so)
  • The individuals at the home birth must be able to easily and immediately contact outside health sources for advice in the case of an emergency
  • The mother should have safe and fast transportation access to a nearby hospital that is prepared to receive her if needed

A baby born at home should immediately receive the care outline in the AAP's "Guidelines for Perinatal Care."

These guidelines include providing warmth to the newborn, using any resuscitation necessary and assigning an Apgar score to the baby.

An Apgar score is a number from 0 to 10 that determines a baby's health immediately after birth. It relates to a child's breathing, circulation and other vital functions.

The best option for warming the baby is skin-to-skin contact with the mother. If this is not possible, heating pads should be available.

If a newborn requires resuscitation involving more than 30 to 60 seconds, the child should be transferred to a hospital or other medical facility for monitoring.

Home births should also provide the following standards of care for newborns:

  • Treatment for group B streptococcal disease if the mother screened positive for it
  • Glucose screening for babies born small or large for the pregnancy week when they were born or for babies born to women with diabetes. The hospital or a birthing center is the safest place for these babies to be born.
  • Eye drops to protect against bacteria
  • Vitamin K to prevent hemorrhagic disease caused by Vitamin K deficiency
  • Vaccination against hepatitis B
  • Assessment of breastfeeding or bottle latch
  • Screening for hyperbilirubinemia
  • Universal newborn screening as required by state law within 1 to 2 days of birth
  • Hearing screening within one month of birth

The AAP added that, along with ACOG, the organization does not support the use of midwives who are not certified by the American Midwifery Certification Board.

The policy statement was published April 29 in the journal Pediatrics. No funding was required for this statement.

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Review Date: 
April 27, 2013