The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

HBAC FAQ - Q&A about Homebirth After Cesarean

Yes, we are having our baby at home with a midwife attending....

You may have some questions about this.  We would like to give you information that will help you understand this choice and be comfortable with it.

Is a home birth safe for you and your baby?

Yes, definitely.  Evidence has shown that, overall, home birth is safer than a hospital birth for both me and our baby.  Some study results follow.

• Perinatal mortality rate for homebirth was 9.5 per 1000 compared to 20.3 per 1000 for hospital births in California.  Mehl LE et al. Outcomes of elective home births: a series of 1146 cases. J Reprod Med 1977.
• Neonatal mortality rate for hospital birth in North Carolina was 7 per 1000 and for home birth was 4 per 1000.  Burnett CA et al.  Home delivery and neonatal mortality in North Carolina. JAMA 1980.
• Neonatal mortality at out-of-hospital births in Kentucky from 1981-83 was 3.5 per 1000.  Hinds MW, Bergeisen GH, and Allen DT.  Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. JAMA 1985.
• “There is no evidence to support the claim that the safest policy is for all women to give birth in the hospital.”  Campbell R and MacFarlane A.  Place of delivery: a review. Br J Obstet Gynaecol 1986.
• Perinatal mortality rate with OBs was 24.3 per 1000 babies.  PMR at homebirths was 2.4 per 1000. Eskes TK.  Home deliveries in the Netherlands--perinatal mortality and morbidity. Int J Gynaecol Obstet 1992.
• One book summed up home birth outcomes as follows: “Excellent outcomes with much lower intervention rates are achieved at home births.  This may be because the overuse of interventions in hospital births introduces risks or the home environment promotes problem-free labors.”  Goer, Henci.  Obstetric Myths vs. Research Realities, 1995.

The short answer: Hospitals are for sick or injured people, and a woman giving birth is not sick or injured.  The long answer: Technology used routinely actually causes more problems than it solves.  Hospital procedures, including routine IVs, external or internal fetal monitoring, taking nothing by mouth, and episiotomy all increase the risk to both mother and baby.  Of course when used appropriately, technology can be life saving. Another couple of incentives to stay away from hospitals: A recent study reported in major media showed that the number one cause of death in hospitals is medical error. Also, a hospital hosts a variety of unpleasant bacteria which you will not find at home.

What if you or the baby has a problem--what does the midwife do?

My team of midwives is fully experienced with the normal course of labor and birth, so that they are able to identify anything that could be problematic as soon as it comes up. In the event of an emergency, they are certified in infant resuscitation.  They carry necessary equipment such as oxygen and medication to control bleeding. They either resolve emergency situations or control them during transfer to a local hospital for care with the backup OB.

But, didn’t you have a cesarean last time?  Shouldn’t you be in the hospital?

Being in the hospital is the main reason why I had a cesarean last time.  If I go back to the hospital, my risk of cesarean is even higher this time because OBs insist on managing VBAC (vaginal birth after cesarean) as a high risk situation.  In most cases the cesarean is actually more risky for both me and our baby.  The only increased risk in VBAC is an unlikely uterine rupture.  Because rupture is so rare, less common than both prolapsed cord and placenta previa, there is no reason for my labor to be considered more high risk than anyone else’s.  If you believe VBAC is too risky, then it follows that every woman should have a cesarean before labor starts.  Ridiculous, right?

What about the postpartum depression you had last time?  Shouldn’t you be in the hospital?

We most certainly hope this will not reoccur, and we are taking steps to prevent or at least lessen the severity of it.  One of those steps is having our baby at home.  In cultures in which women give birth at home, postpartum depression is much less common than in the US.  One study showed a rate of less than one percent.

But you will feel horrible if something happens to your baby at home!

Of course I will be devastated should something happen to our baby. But, I actually see it just the opposite.  If I were in the hospital and something happened, I would feel worse, because I would know that that outcome would have been less likely to happen at home.

Don’t you think you are taking a big risk by doing something like this?

Life is full of risks, and there are no guarantees of absolute safety in any endeavor. However, we have weighed the risks and benefits of these options over the last three years, and there is no doubt in our minds that home is the better place to be.

And a final question we hope you will ask-- What can I do to help?

We hope you can see that we have made the best choice for us.  Even if you don’t agree with us, we hope that you will respect us enough to support us and not criticize us.  We need your support, encouragement, and prayers.  Practical help after the baby is born will also be welcomed. Thank you for your love and support!

Some books you may want to look into for more information:

by Jenny Jamison Griebenow, griebenow@iclub.org
married to Greg 7/30/88
SAHM to Zachary 8/24/95
and a new person, to debut in late August 2000
U of Tulsa BA ’89 MA ’91, Phi Beta Kappa
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Birth is as safe as life gets.
  --Harriett Hartigan