ACOG Interim Update on Planned Home Birth (April 2017)

Recommendations

  • 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 planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000). These observations may reflect fewer obstetric risk factors among women planning home birth compared with those planning hospital birth. Although the American College of Obstetricians and Gynecologists (the College) believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery.
  • Women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system; ready access to consultation; and access to safe and timely transport to nearby hospitals.
  • The Committee on Obstetric Practice considers fetal malpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth. READ ENTIRE COMMITTEE BRIEF HERE

Table 1

Table 2Abbreviation: CI, confidence interval.

*Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol 2013;209:325.e1–8.

Snowden JM, Tilden EL, Snyder J, Quigley B, Caughey AB, Cheng YW. Planned out-of-hospital birth and birth outcomes. N Engl J Med 2015;373:2642–53.

Grunebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B, et al. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol 2013;209:323.e1–6.

§Includes planned birth center and home births.

For More Information

Planned Home Birth (PDF), American Academy of Pediatrics
This policy statement is intended to help pediatricians provide supportive, informed counsel to women considering home birth while retaining their role as child advocates. It also summarizes the standards of care for newborn infants born at home, which are consistent with the standards for infants born in a medical care facility.

Global Standards for Midwifery Education (PDF), International Confederation of Midwives
These standards promote regulatory mechanisms that protect women and families by ensuring that safe and competent midwives provide a high standard of midwifery care to every woman and baby.

Global Standards for Midwifery Regulation (PDF), International Confederation of Midwives
These standards define the expectations for competencies and scope of midwifery practice to promote the health of women and childbearing families.

Essential Competencies for Basic Midwifery Practice (PDF), International Confederation of Midwives
These essential competencies complement the International Confederation of Midwives (ICM) standards and guidelines related to midwifery education, regulation, and clinical practice.

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