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What are the risks of home birth? Who is home birth right for? Who is a birth center right for?
In the last blog post, we took a broad look at the different options and why some expectant parents feel safer in-hospital, while others feel safer out-of-hospital, but who is out-of-hospital birth right for? You might be surprised to find that In the US, this is not so clear cut.
In many countries outside the US, clear definitions of who is right for out-of-hospital birth and who needs to be in hospital have been established, so it is much easier for expectant parents and their care team to evaluate who out-of-hospital birth is appropriate for and who may be safer in a hospital.
In the US, these systems are not in place and, further midwives, who are usually the birth professionals attending out-of-hospital birth, are not always accepted as peers by doctors in the local hospitals, which can make it difficult for them to make proper referrals for women who may not be suited to out-of-hospital birth, and dangerous if they decide they cannot make the referral.
Inside the US, the degree to which this occurs will vary among states depending on how the birth culture has developed and whether or not licensed or certified midwives are able to practice in your state.
Some health conditions make it more obvious than others where the most appropriate place to birth will be, for instance, placenta previa, breech positioning, multiples and other conditions that are more likely to involve complications in labor and birth, are highly likely to take place in a hospital setting. But what about non-health related reasons like age? Or whether it's your first pregnancy or not? Or a vaginal birth after cesarean (VBAC) in an otherwise healthy woman who had a non-complicated C-section?
The current recommendations are for women of "advanced maternal age", which is 35, to birth in hospital. First time moms are also often encouraged to birth in a hospital, because they have an "untried" pelvis and therefore are considered more likely to fail, until it is proven that they can succeed. VBAC's have been very controversial, but as surgery techniques have improved, more moms are having successful VBAC's and more hospitals are supporting a trial of labor rather than recommending a repeat C-section, although VBAC's are not yet recommended to be tried out of the hospital.
None of these three situations, age, first pregnancy or even uncomplicated VBAC, have any evidence basis to show these births will be any less safe in an out-of-hospital setting than any other healthy pregnancy. At this time, these recommendations are based on the general fear of birth and lack of research, so it is no surprise that expectant parents who fall into these categories are unsure of what choices to be making. If you live in an area with access to licensed or certified midwives, don't rule out alternate birth setting options, explore all the options available to you and meet with different birth professional in your area to learn what your options are.
If you want to learn more about your childbirth options and preparation, check out our website to learn about our membership program for expectant parents NaturalBirthCompass.com.
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