Pregnancy is often a time of high anxiety – even when there’s not a global pandemic going on. The images on the media of overflowing hospitals and conflicting articles bombarding your social media feeds make it hard to tease out the facts from opinion. I know that many of my patients are petrified by the idea of contracting the COVID-19 virus. My heart breaks for my patients as I see the fear in their eyes as they ask if they should have a home birth to avoid the hospital during the pandemic. My answer to them: No, home birth is not the answer.
Birth in a hospital is still safer for you and your baby than a home birth in the United States. Much like flying on a plane the day after a plane crash, right now, everyone working in labor and delivery rooms across the country is on high alert. All medical professions take cleanliness and sterile procedures seriously, but this virus has caused everyone to take precautions to the next level. Life-threatening labor complications such as hemorrhage and preeclampsia are not going to stop occurring just because there is global pandemic and are much more likely to happen to you than death from COVID-19. Additionally, there are case reports of women whose COVID-19 symptoms presented while they were already in labor (they didn't get the virus from the hospital, they had been unknowingly exposed days before), and their lungs deteriorated very quickly needing intensive care shortly after birth. Delivering in the safety of a hospital where these all these issues can be quickly addressed is still the safest option.
While it is true that, in the US, mothers attempting planned home birth are less likely to have medical interventions such as episiotomies or cesarean sections, babies born during planned home birth are twice as likely to die in the first month of life and three times more likely to have permanent brain damage than babies born in the hospital. And even if, despite the risks, you wanted to change your plan to home birth, it may be difficult to find a qualified home birth provider with availability for new clients in the third trimester. Home birth is risky enough, but delivering without a qualified attendant would be even more dangerous. The internet opinions on home birth are quite polarized, and the data can be challenging to sift through. Most pro-home birth data is based out of countries such as the Netherlands, where 13% of the population delivers at home – but it’s very important to note that they have a much better safeguards in place than we do in the US.
Another consideration would be that around 10% of planned home births end up being transferred to a hospital during labor. For first time moms, the transfer rate is up to 23% and for women who have had previous vaginal deliveries the rate is 8%. As ambulances and emergency rooms are feeling the brunt of the crisis right now, getting to the hospital quickly could be a challenge depending on the impact COVID-19 is having in your area.
I know many of you are heartbroken that you mom, sister, doula, aunt, or whoever you have always pictured with you during your birth may not be able to be at your side. I feel for you, I really do. We are all dealing with our new normal and figuring out how to navigate this crisis. You will have one support person in labor and a team of nurses and doctor who are literally putting their life on the line to help you.
If you were already planning a home birth before the current crisis, while that is not a choice I would medically recommend, I respect your autonomy and support your right to choose the birth experience that is right for your family. If you are considering home birth out of fear of contracting COVID-19 or frustration that you can't have as many visitors as you would like, please take all the facts and risks into consideration. Talk to your doctor or midwife about your specific risk factors and what is safest for you and your baby.