With increasing maternal mortality rates in the United States, the importance of the search for safe options for pregnancy and birth is a priority for multiple organizations, and home birth could be the answer for low-risk parents (Neerland et al., 2022). Midwife-led out-of-hospital birth is a safe option for low-risk birthing parents because it embraces the midwifery model of care, which reduces maternal mortality rates by decreasing cesareans and medical interventions while empowering the birthing parent regardless of sexual or gender orientation.
Research conducted on the safety of out-of-hospital birth with midwives following the midwifery model of care has shown that home birth is a safe option for birthing people. In addition, studies show that “birth center care in the United States has demonstrated safe outcomes for childbearing individuals and families, including high rates of spontaneous vaginal birth, low rates of cesarean birth, lower rates of obstetrical interventions, and lower rates of NICU admissions.”(Neerland et al., 2022, p.8). This paper explores how out-of-hospital births supported by a midwife provide a safer experience for families.
A significant reason that home birth is a safe option for birthing parents is that midwives train under the midwifery model of care. This model provides high-quality care by building in-depth relationships with clients through their pregnancy into postpartum. It also prioritizes safe and respectful care of birthing people by centering parents in their care (Thumm, 2018). Additionally, providing comprehensive and safe care that includes all birthing parents is a priority of midwives following the midwifery model. Goldberg et al. (2022) stated that “Midwifery tenets and regulations underscore the ethical duty of midwives to ensure the provision of safe, inclusive, and quality care to all clients.” (p. 2). The midwifery model of care contributes to out-of-hospital birth being a safe option by centering birthing parents in their pregnancy and birth journeys. Research also shows that this care model has improved families’ experiences by reducing cesarean sections and unnecessary interventions, increasing the vaginal birth after cesarean rate, empowering families, and providing inclusive care to all birthing parents.
Midwifery-led out-of-hospital midwifery care safely reduces the cesarean rate and increases VBACs (Cheyney et al., 2014). 94% of birthing parents planning a home birth had vaginal births, which is substantially higher than hospital vaginal birth rates in the United States (Cheyney et al., 2014). A study by Waterman (2017) found that birthing parents were safe and much more likely to have a successful VBAC when in a low-risk birth setting and cared for by midwives rather than in an obstetric unit. The risks of cesarean include “longer recovery and hospital stay, increased risk of infection, intensive care admission, thromboembolism, peri-operative haemorrhage, anaesthetic complications, maternal death, and a higher incidence of neonatal respiratory morbidity”(Waterman, 2017, para. 6). Out-of-hospital care reduces the rate of maternal morbidity and mortality and increases safety for birthing parents by reducing cesarean section rates.
Along with reducing the rate of cesarean sections, home birth with midwives also reduces the rate of medical interventions birthing people experience during their labor and birth journey (Cheyney et al., 2014). Research on the reduction of interventions during home births found that less than 5% of birthing parents used oxytocin to augment their labor or epidural analgesia for pain management (Cheyney et al., 2014). The side effects of oxytocin are maternal pain, placental abruption, uterine rupture, cesarean section, postpartum hemorrhage, postpartum infection, and excessive uterine activity, which can cause fetal hypoxemia and fetal acidemia (Simpson, 2011). Therefore home birth is a safe option for birthing people because they are less likely to encounter medical interventions and the risk of the interventions themselves is reduced.
Parents who plan for a home birth with midwives following the midwifery model report feeling empowered with knowledge and individualistic care that meets their family’s unique needs (Neerland et al., 2022). Birthing people that feel supported with individualistic and respectful care from midwives feel safer holistically (Neerland et al., 2022). Having comprehensive prenatal visits with their midwifery provider also helps birthing people build trust with their birth team, and this trust leads to confidence in the labor and birth journey (Neerland et al., 2022). Birthing parents report feeling safer and supported while under the care of a midwife because they can build in-depth relationships with their care provider and become empowered with knowledge about their bodies and the birth process.
Out-of-hospital midwifery care provides safe and inclusive care to birthing parents who identify as sexual and gender minorities. Goldberg et al. (2022) stated in their research that “midwives are poised to play a crucial role in improving the care experiences of SGM individuals, and understanding how attitudes are shaped can inform future work to build midwives’ capacity to provide safe, inclusive, and quality care to all SGM people“(p. 11). The inclusive and safe care provided by midwives is crucial for sexual and gender minorities. This is because “discriminatory attitudes of health professionals are often experienced as homo-, trans-, and biphobia by SGM patients and have been shown to negatively affect patient care” (Goldberg et al., 2022, p. 2). Midwives supporting out-of-hospital births often provide safe and respectful care to their clients regardless of their sexual orientation or gender. They are crucial in providing adequate care for marginalized groups that often face discriminatory attitudes.
Research has shown that midwife-led out-of-hospital birth is a safe and effective option for families wanting inclusive and respectful care. “The impact of midwife-led care and the nature of the birth setting are fundamentally interdependent in the chain of cause and effect leading to more positive birth outcomes” (Waterman, 2017, para. 1). Midwives provide safe care by following the midwives’ model of care which prioritizes client safety and individualistic care that empowers families. This midwifery care model continuously proves to reduce cesarean rates, increase vaginal birth after cesareans, decrease unnecessary interventions, help parents feel safe, and provides safe and respectful care to birthing parents who identify as sexual and gender minorities. While maternal mortality continues to be a considerable concern in the United States, midwifery-supported out-of-hospital birth could provide a safe option for low-risk families.
Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of care for 16,924 planned homebirths in the United States: The Midwives Alliance of North America statistics project 2004-2009. Journal of Midwifery and Women’s Health, 59(1), 17–27. https://doi.org/10.1111/jmwh.12172
Goldberg, J. M., Shokoohi, M., Graf, T., & Ross, L. E. (2022). Measuring the attitudes of midwives toward sexual and gender minority clients: Results from a Cross-Sectional survey in Ontario. Birth. https://doi.org/10.1111/birt.12658
Neerland, C. E., Delkoski, S. L., Skalisky, A. E., & Avery, M. D. (2022). Prenatal care in US birth centers: Midwives’ perceptions of contributors to birthing people’s confidence in physiologic birth. Birth. https://doi.org/10.1111/birt.12676
Simpson, K. R. (2011). Clinicians’ guide to the use of oxytocin for labor induction and augmentation. Journal of Midwifery and Women’s Health, 56(3) 214–221. https://doi.org/10.1111/j.1542-2011.2011.00052.x
Thumm, B. E., & Flynn, L. (2018). The five attributes of a supportive midwifery practice climate: A review of the literature. Journal of Midwifery Women’s Health, 63(1), 90–103. https://doi.org/10.1111/jmwh.12707
Waterman, K. (2017). Does a low-risk setting in the intrapartum period increase VBAC success rate? A literature review. MIDIRS Midwifery Digest, 27(1), 59–67. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovfts&NEWS=N&AN=00115386-201727010-00016.
Jenni Jenkins – Sekine is an Oklahoma Bereavement, Birth, & Postpartum Doula and Child Birth Educator who serves her Central Oklahoma community. She is also a midwifery assistant with Holistic Birthing Services and began her journey as a student midwife with the Midwives College of Utah in 2022.
To learn more about Jenni, please click here.