Home Birth Still Vastly More Dangerous

Kim Lundeen

April 24, 2020

Considering the growing number of COVID-19 cases at hospitals, many expectant mothers wonder if they can avoid the hospital altogether. However, women need to know that home birth carries a many-fold increased risk of their baby dying during birth or shortly after. Giving birth in a hospital is still the safest choice.

Most women (98.4% in 2017) choose to give birth in a hospital, however out-of-hospital (meaning at home or a dedicated birth center) births have been gaining in popularity in the U.S., mainly among affluent white women. During this pandemic, women worry about catching COVID-19 at the hospital, and rightly so. In Minnesota, as of Friday, April 24, 278 people were hospitalized for COVID-19, however 90 of those are segregated at Bethesda Hospital in St. Paul, the metro’s dedicated COVID-19 hospital.

The data on COVID-19 in pregnancy and infants is still sparse, but so far the virus does not appear to be transmitted from mom to baby while in the womb, during the birth process, or through breastmilk. Even when babies and/or moms test COVID-19 positive, outcomes have been relatively good - pregnant women and infants may even be more likely to be asymptomatic if infected.

Other than contracting COVID-19, fears of expectant mothers around hospital birth include visitor restriction (not being able to have support people during labor) and being separated from their baby after birth if they test positive for COVID-19.

Twin Cities area hospitals have a wealth of online resources for expectant families (Fairview M Health, Allina (Mother Baby Center), HealthPartners, Hennepin Healthcare, North Memorial) on how they are handling this pandemic. Precautionary measures include increased cleaning of facilities, increased use of personal protective equipment (PPE), and limiting visitors (though most allow at least one visitor for laboring mothers). Some hospitals across the nation test all women admitted to labor and delivery for COVID-19.

Despite these preventative steps, some women feel that the risk of contracting COVID-19 at a hospital outweighs any benefit of safety that the hospital provides. Facilities like birth centers may also be too anxiety-provoking, leading women to consider home birth. I’ll reiterate again that this is not a safe option in the U.S., and here’s why.

Home births are typically supervised by a midwife instead of a medical doctor, and importantly, training among midwives varies significantly. If a midwife is not licensed and certified in the U.S., it is very unlikely that certain safety standards will be met. Ask your chosen midwife about their level of training and what their back-up plan for hospital transfer is before you put yourself and your baby at risk of harm.

Despite the allure that a home birth may provide, all OB/GYNs very strongly recommend giving birth at a hospital or accredited birth center based on the published dramatic increased risk of maternal and neonatal death associated with home birth in the U.S. There is solid evidence from a large study conducted in Oregon, the state in the U.S. with the highest percentage of babies delivered at home, that home birth comes with at least a 2-3 times increased risk of your baby dying during childbirth. Certain nuances in the interpretation of the data, such as the fact that the study only included very low risk women, mean that the risk of neonatal death is likely much higher than this study suggests.

If considering a home birth, there are many things to consider. If you’re having twins or triplets, if you’ve had a prior cesarean section, or if your baby is breech, you should under no circumstances plan to deliver at home. Certain other risk factors make giving birth at home more risky, including if this is your first baby, you have issues with blood pressure or diabetes, or if your baby is preterm (<37 weeks), among others. If these apply to you, it is much more likely that you will need to be transferred to a hospital to deliver your baby safely. In an emergency, minutes and even seconds matter, especially in the case of hemorrhage, shoulder dystocia (where the baby gets “stuck” in the birth canal), or if your baby needs to be resuscitated after birth. And in an emergency situation, your risk of COVID-19 is much higher than if you were admitted to the hospital in a controlled, planned manner.

Please contact your healthcare provider if considering a home birth. Above all else, the medical community wants to ensure both you and your baby are safe and healthy, and a hospital is the best place to deliver safely. In the midst of this global pandemic, childbirth is still a beautiful and special time in your family’s life.