photo courtesy of debit72
Clearly there are issues in the home birth midwifery here in the States, as the numbers continue to show us the increase risk for babies born at home (you can read the studies by clicking here). In my opinion, based on what I have seen, it is because too many risks are taken -- risks that pregnant women may or may not be aware they are taking. What makes home birth safe? Here are my thoughts on the matter. My stipulations are based on the standards set by other countries where home birth has shown to be a safe option.
1. The mother is low risk and takes the proper screening measures to ensure that she remains low risk through the pregnancy and through labor/delivery -- otherwise care is transferred to an OB (or hospital, if during labor/delivery).
2. The birth attendant is a trained and certified midwife with current hospital privileges and OB back-up (which basically means your midwife is either a Certified Nurse Midwife or a Certified Midwife). I think it is important for a mother to meet with the back-up OB at least once during pregnancy. That way, if any complications develop later in pregnancy and she needs to transfer care, she can transfer to someone she has already met and to someone she knows her midwives trust.
3. A second attendant or midwife is present for labor/delivery -- someone that is trained to assist in birth (certified in CPR and neonatal resuscitation). In case mother and baby both need assistance after the birth there is one trained professional for each.
4. Close proximity to a hospital where the mother is preregistered in the event of a transfer (10 miles max -- even that seems too far, in my opinion)
5. Monitoring every 15-30 minutes during first stage of labor; monitoring every 5 minutes in second stage of labor. Anything less than that is falling outside the guidelines of evidence based care.
6. The midwife should have current insurance. This is to protect the family and the midwife in case something goes wrong. I know you can't imagine suing your home birth midwife if something went wrong. However, for example, if a birth injury occurs and the child needs lifelong medical assistance because of it, then you are certainly entitled to compensation to help pay for those medical bills.
7. The mother is not a first time mom. Home birth for a first time mother carries a higher risk for the baby.
Those are my suggestions. If you cannot check off all of these items for your home birth (or birth center birth), then it is not something I could get behind and call "safe." With the ever increasing interest in mothers wanting a home birth, I can only hope more midwives take reasonable measures like these to ensure only the safest options for their clients. I know there are home birth midwives that stick to these guidelines and that is wonderful!