The American College of Obstetricians and Gynecologists Issues Opinion on Planned Home Births
Washington, DC -- The American College of Obstetricians and Gynecologists (The College) issued a Committee Opinion today that says although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births.* A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births.
"As physicians, we have an obligation to provide families with information about the risks, benefits, limitations and advantages concerning the different maternity care providers and birth settings," said Richard N. Waldman, MD, president of The College. "It's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries." Based on the available data, The College believes that hospitals and birthing centers are the safest place for labor and delivery.
Although The College does not support planned home births given the published medical data, it emphasizes that women who decide to deliver at home should be offered standard components of prenatal care, including Group B Strep screening and treatment, genetic screening, and HIV screening. It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency.
The recommendations state that a prior cesarean delivery is an absolute contraindication to planning a home birth due to the risks, including uterine rupture. Women who want to try for a vaginal birth after cesarean are advised to do so only in a hospital where emergency care is immediately available. Attempting a home birth also is not advised for women who are postterm (greater than 42 weeks gestation), carrying twins, or have a breech presentation because all carry a greater risk of perinatal death.
Committee Opinion #476, "Planned Home Birth," is published in the February 2011 issue of Obstetrics & Gynecology.
*Referring to the Wax meta-analysis, whose conclusions excluded the largest study of home birth and included flawed studies known to include unplanned home births.
For related reading on home birth position statements, please visit:
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AMA on home birth
RCOG and RCM on home births
Responses to ACOG
10 responses to ACOG's position statement on home birth