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Due to a slow rising number of home births in America, the American Academy of Pediatrics (AAP) has released a new policy statement, “Planned Home Birth.” Published this week, in the May issue of Pediatrics, the AAP policy focuses on infant care after the birth, but offers other home birth tidbits as well. The policy also highlights what makes a woman a good candidate for home birth, which according to the AAP is as follows:

  • Women with absence of preexisting maternal disease.
  • Women free from significant diseases during pregnancy.
  • Women carrying one child, not multiples.
  • Women carrying babies with a cephalic presentation (i.e. head-first, not breech).
  • Women who carry their baby to term.
  • Women who experience spontaneous labor or who are induced as an outpatient.

The AAP also states that some very specific systems should be in place before a woman becomes a home birth candidate — including, availability of a certified nurse-midwife, certified midwife, or physician to deliver the baby, at least one trained individual to care for the newborn, access to consultation and access to safe and timely transport to a hospital if needed.

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What Else is Included in the Policy?

There are some helpful tips within this new policy. For example, the AAP points out some obvious facts, such as skin-to-skin contact with a mother is an effective baby warming system, but portable warmers should be made available as well. They remind home birth care providers that infants who need resuscitation should be monitored frequently, and if extensive resuscitation is necessary, an infant should be taken to a medical facility. Additionally, the AAP says that infant care during a home birth needs to include:

  • Basic care – cleaning, keeping baby warm, etc.
  • Universal newborn screening including hearing screening
  • Monitoring for group B streptococcal disease
  • Glucose screening
  • Eye prophylaxis against gonococcal ophthalmia neonatorum
  • Dose of vitamin K
  • Hepatitis B vaccination
  • Assessment of breastfeeding
  • Screening for hyperbilirubinemia
  • A plan in place for follow-up care for mom and baby

As you can see, many of the recommendations are very hospital-minded, including their recommendation that only doctors or midwives certified by the American Midwifery Certification Board should attend a home birth; something that’s rattled many other types of midwives.

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The Real Message Behind This Policy – Home Births are BAD NEWS

The AAP policy specifically states that during the prenatal period, physicians should inform women who ask about home birth about, “The risks and benefits [of home birth] based on recent evidence.” Based on this very specific statement, it stands to reason that the AAP would list both risks and benefits of home birth in their policy so that physicians could do their job. However, the new policy undeniably frowns on home birth. Here’s the short list of home birth cons offered in the policy:

  • Hospitals and birthing centers are the safest settings for birth in the U. S.
  • A woman’s choice to plan a home birth is not well supported in the United States.
  • Geography may adversely affect the safety of planned home birth.
  • Planned home births are associated with a two- to threefold increase in neonatal mortality.
  • Home birth places a larger burden on health care providers.
  • Infants born at home miss out on typical hospital and birth center safeguards.
  • Obstacles to home birth are pervasive.
  • Infants born at home are at risk for low Apgar scores and neonatal seizures.

As for those home birth benefits the AAP says physicians should discuss. Well, they’re non-existent in the new policy. In fact, after reading through the policy (more than once) I was only able to find a single, solitary, half-handed benefit noted by the AAP, which is, “A small study of all planned home births attended by midwives in British Columbia, Canada, revealed no increase in neonatal mortality over planned hospital births attended by either midwives or physicians.”

Try to take this new policy with a grain of salt. Remember, when home births happen, hospitals lose patients — and they don’t like that. So, this policy makes sense in that respect. Still, if you’ve had your heart set on a home birth, do plenty of your own research, starting with the following links:

+ AAP Issues Guidelines For Care of Infants in Planned Home Births