Planned Home Birth: A New View

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The ACOG acknowledges that women have the right to make informed choices about home birth after thorough counseling about risks and benefits.

In the U.S., 25,000 births (0.6%) occur at home annually. The American College of Obstetricians and Gynecologists (ACOG) has issued an updated committee opinion on planned home birth. Because data on the safety of home birth are limited (JW Womens Health Mar 7 2006), the statement relies primarily on a meta-analysis of observational studies of planned home births versus hospital births (Am J Obstet Gynecol 2010; 203:243.e1). This study showed that, although absolute risks were low, planned home birth was associated with twofold higher risk for neonatal death than was hospital birth (risk was threefold higher when anomalous newborns were omitted from the analysis).

The committee recommends that women who are considering planned home birth should adhere to strict selection criteria (e.g., absence of preexisting or pregnancy-related disease, singleton fetus, gestational age >36 weeks). In addition, the following resources should be readily available:

* Means of safe and timely intrapartum transfer * Integrated care system for expedited transport and backup arrangements * Certified nurse-midwife, certified midwife, or physician in attendance who is integrated with an existing healthcare system to facilitate transport to a hospital

The committee emphasized the need to respect the rights of women to make medically informed decisions about delivery and stressed that women who are planning home births should be made aware of the risks and benefits (particularly to their newborns) through adequate counseling.

Hopefully RANZCOG will soon amend their policy statement on home birth along similar lines to the revision above. Ideally, the professional bodies for obstetricians and midwives will be able to come together and write a combined policy statement on planned home birth. The RCOG and RCM have achieved this.

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