Home birth: Better for baby in the long run?

The new CDC report on home birth is everywhere, media-wise, including CNN  and NPR. Deservedly so–Marian MacDorman (from the CDC) and Eugene Declercq (Boston University School of Public Health) have teamed up on excellent studies of a number of maternity care topics, including cesarean section, VBACs, and, of course, home birth. Their work is always trustworthy and accurate.

Not mentioned in the CDC report (because it wasn’t really the subject) are the benefits to the home-born baby, particularly in terms of the development of the immune system, and lessened risk of future chronic diseases like asthma, eczema, diabetes and obesity.

As the safety issues of home birth are brought more clearly into focus–the Birthplace in England study showed that, in a well-integrated maternity care system (which most of the U.S. is not, at present), home birth for women having a second or subsequent birth is as safe as a hospital birth–the long-term health advantages for the baby should be included as a prominent part of the discussion.


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6 responses to “Home birth: Better for baby in the long run?

  1. I appreciate your comments about including the long-term benefits of home birth in the discussion. With all the debate about safety issues, which as you pointed out has been firmly established in countries with well-integrated midwife-led maternity care systems, these longer-term benefits to both baby and mother are not being heard. I look forward to the day when the safety debate is laid to rest in the U.S. and we can move on to answering other important questions about how exactly these excellent outcomes can be achieved in all settings for all low-risk women and babies.

    Wendy Gordon, CPM, LM
    Midwives Alliance Division of Research


  2. Thanks for this post, Dr. Sloan. The long-term as well as short-term benefits for babies from out-of-hospital birth are important factors for parents and policymakers to consider. The MacDorman/Declercq study points out that low birth weight and prematurity weights for home birthed babies are half the rate shown for hospital-born babies. It is not only a matter of good risk analysis on the part of OOH midwives, but also the type of prenatal care provided by midwives that makes such a difference. The data being generated by midwives like Jennie Joseph, LM, CPM, at her Florida birth center indicate that midwifery care for prenatal services can significantly lower rates of low-birth weight and prematurity, including in populations which have otherwise displayed disparities of outcomes related to race, ethnicity, income level, or youth. The 1989 NEJM National Birth Center Study and the 2005 SMJ CPM Home Birth Study show the same strong results across ethnic and racial cohorts. What is needed in the US is greater access to midwives and birth centers for all women, not only for middle class married white women.


  3. Thank you SO much for your comments and support of home birth and CPMs. I hope that North Carolina legislators will FINALLY make home birth with a CPM legal, licensed and regulated!


    • Kim – thanks for writing. Just to be clear, I’m a supporter of qualified midwives providing home birth services, whatever their organization. Whether they are CPMs, CNMs or one of the other types of “M”s, the keys, as you mentioned, are training, licensure, regulation and also an improved working relationship between the home birth and hospital environments. That’s a lot of keys–a veritable key-ring-full–and all of them are critical. Home birth can only succeed if it’s a “normal” part of maternity care in the U.S.


  4. Thank you Dr. Sloan! In my home state of Maryland we are trying to bring our CPMs into the system but being fought tooth and nail by Nursing and Physicians Boards and MedChi. The demand for homebirth in our state can’t be met by the four CNMs we have who currently operate home birth practices and more and more women are turning to unassisted birth. Its great to have an MD voice saying that a fully integrated system with ALL credentialed midwives should be the goal.


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