Every family has a right to experience childbirth within a context that respects cultural variations, human dignity, and self-determination. While the majority of women in the United States choose hospital births,some families desire home births or births in an out-of-hospital birth center.
The safety of birth in any setting is of utmost priority and has been the focus of home birth research. Investigators have defined “planned home birth” as the care of selected pregnant women by qualified providers within a system that provides for hospitalization when necessary. Recently, high quality controlled trials and descriptive studies have established that planned home births achieve excellent perinatal outcomes. Home birth is also credited with the reduced use of medical interventions that are associated with perinatal morbidity.
Unfortunately, studies which have not differentiated between planned and unplanned home birth, or attendance by qualified versus unqualified attendants, and/or that do not clearly define appropriate inclusion criteria, have been used to discredit all home birth. The evidence indicates that appropriate client selection, attendance by a qualified provider, sound clinical judgment, and transfer to a receptive environment when necessary all promote safe outcomes.
The ACNM has established clear guidelines for home birth and publishes a handbook that addresses selection criteria for home birth clients, mechanisms for medical consultation and transfer, and the establishment of quality management systems. The informed consent process for home birth includes the delineation of potential risks and benefits of each available birth site and provision for transport if conditions require personnel and/or equipment available only in the hospital setting.
The home birth setting provides an unparalleled opportunity to study and learn from normal, undisturbed birth. Medical and midwifery students who understand the characteristics of normality are better equipped to recognize deviations from normal. Insights into effective care in pregnancy and childbirth may be derived from clinical experiences with home birth families or from the study of normal birth at home.
In accordance with evidence-based and ethical practice, the American College of Nurse-Midwives(ACNM):
- Supports the right of women who meet selection criteria to choose home birth.
- Recognizes certified nurse-midwives (CNMs) and certified midwives (CMs) as providers who are qualified to attend planned home births.
- Encourages the promotion of clinical experiences with home birth in education programs.
- Encourages third party payors to reimburse qualified providers for home birth services.
- Urges professional liability insurance carriers to provide coverage for qualified providers who attend home births.
- Urges all healthcare providers and institutions to collaborate in the creation of seamless systems of care when transfer is needed from the home to the hospital setting.
- Recommends that further studies focus on the characteristics and management of normal birth, markers of morbidity as they relate to birth site, and qualitative assessments of client satisfaction and experience as they relate to planned home birth.