Tanya Smith-Johnson has given birth to four healthy babies: two in a hospital and one in a birth center attached to a hospital. Her fourth was born at home, with the help of a midwife. Though the experiences were similar in many ways, Smith-Johnson -- who enrolled in medical school, but stopped after one year -- said she'd had to justify the home birth to friends and family in a way that wasn't necessary with the others.
"Because I had been in med school, people were almost horrified that I would make that choice, thinking that it was a bit reckless," she said. "They had all these questions ... 'What does [the midwife] do? Do they have medicine?' ... I had to explain so much."
"I always trusted that home birth can be as safe as hospital birth," Smith-Johnson said. "But the numbers weren't there for the world, so to speak."
A new study tracking the safety of home birth in the United States has taken a major step in that direction, its authors believe, finding that outcomes among women who had planned, midwife-led home births were "excellent," and that the women experienced relatively low rates of intervention.
The study, published in the Journal of Midwifery & Women's Health on Thursday, looked at the home birth outcomes for roughly 17,000 women as recorded in the Midwives Alliance of North America data collection system between 2004 and 2009.
"There's a large body of research that shows that home birth is safe in other high-resource countries ... but there's been some ongoing question about whether those data can actually transfer to the United States," Melissa Cheyney, an associate professor of Medical Anthropology at Oregon State University, told The Huffington Post. "Is home birth safe in the United States, when there isn't a system of integrated care between home birth, birth centers and hospitals? This study is important because it's a first step in the right direction."
Roughly 94 percent of the women in the study had a vaginal birth, and less than 5 percent required oxytocin augmentation (which is used to make contractions stronger and closer together), or an epidural.
Eleven percent of the women who intended to give birth at home were transferred to a hospital. The primary reason for transferral was failure to progress, followed by desire for pain relief, fetal distress and maternal exhaustion. Approximately 1,100 women in the study were attempting a vaginal birth after cesarean section, and of that group, 87 percent were able to deliver vaginally.
Newborn outcomes were also largely positive, the researchers say. One and a half percent of the newborns had a low Apgar score, which is a measure of a baby's health in the first minutes after birth, and 2.5 percent were admitted to the intensive care unit in a hospital at some point during the six weeks after birth. Six weeks after delivery, more than 97 percent of newborns were at least partially breastfed.
Complications were more common among high-risk women -- for example, those whose babies were breech, those who had multiples or those who had certain conditions, such as preeclampsia.
Dr. Jeff Chapa, director of maternal fetal medicine at the Cleveland Clinic -- who did not work on the study, but had reviewed it -- argued that many high-risk women should not attempt a home birth at all. "Those are patients that, in no uncertain terms, should be delivered in a hospital," he said.
Currently, only 1 percent of all births in the U.S. occur in homes or birth centers, although home birth is on the rise. Recent estimates suggest that the proportion of home births increased by 41 percent between 2004 and 2010, with 10 percent of that increase happening in the last year of that period.
Still, home birth has many critics. An opinion piece published last week in the Journal of Medical Ethics called for further investigation into the risk of avoidable, longterm disability associated with home birth, and likened it to driving without a seatbelt.
"Most children will be unharmed," the authors wrote, according to NBC. "Some trips are very safe. And wearing a seat belt will not remove all risk of injury or death ... But on balance it is much safer with a seat belt."
Chapa cautioned against drawing any conclusions from the new study, as it relies on observational data, and noted that the American College of Obstetricians and Gynecologists believes hospitals and birth centers are the safest settings for birth.
Though he said low-risk women who want a home birth "can feel good in that they're probably going to be OK," he said he was not particularly swayed by the study. "The bottom line in all of this is you can't predict who is going to have an issue or a complication," Chapa added.
But mothers like Smith-Johnson, who have had safe, happy home births, say the experience is unlike anything else. Though she had what she described as uneventful, natural births with all of her children, her home birth stood out.
"It was so beautiful to have my baby, and be right up in the bed after. It was just me and my baby, and he was on my chest," said Smith-Johnson, who is now training to be a midwife herself. "It was tender, and I was being told how powerful I was."
"What I see [in the U.S.] is two very staunchly opposed groups who have dug in their heels," Cheyney said of the home birth debate. "One group will argue home birth is safe enough and it should be a woman's right to choose, and the other side will argue that because it's so dangerous, it's simply unethical for physicians to participate in their care. What I would say is that who is hurt in that is women."