Home Births: Your Safety, Your Rights

The number of home births in the United States has increased significantly in recent decades.  Even with medical advances, home births are still sometimes deemed controversial, which is why we have created this helpful article titled “Home Births: Your Safety, Your Rights.”

This article aims to provide helpful information about home births in the U.S., the risks involved, and your rights if you receive substandard care or an injury occurs.

Home Births: Your Safety, Your Rights

Percentage of U.S.  Home Births

In the early 20th century, the vast majority of births were home births.  It was not until the 1940s that the percentage to home births decreased to 44 percent.  The dramatic decrease in home births is largely attributed to medical advances, better obstetrical and gynecological monitoring, and easier access to hospitals.  In the past two decades, however, the power of choice has once again set the number of home births on the rise.

Between 2004 and 2009, the number of home births in the U.S.  increased by 29 percent.  While this increase suggests that more women may be taking control of their birth experiences, it does not mean that home births are always the safest, most appropriate choice.

Home births are still considered somewhat controversial, and in total, less than one percent of all births are home births.

Who Delivers the Baby in a Home Birth?

One of the most important factors of home births are that they do not necessarily include a physician or hospital-standard monitoring equipment.  Home births are largely attended by midwives, which may include certified nursing midwives (CNM), certified professional midwives (CPM), or non-certified individuals serving in the midwife capacity.  The U.S.  Centers for Disease Control and Prevention (CDC) noted the following about home births in 2009:

  • 62 percent were attended by midwives, compared to only 7 percent in hospitals
    • 19 percent CNM
    • 43 percent CPM or direct-entry midwives
  • 5 percent were attended by physicians, compared to 93 percent in hospitals
  • 33 percent were attended by “other” attendants, which may include an emergency medical technician (EMT), or family member

CPMs are among the medically preferred option for home births, as these individuals are trained and certified in their craft, and must be re-certified every three years.

Currently, only 27 states have licensure programs for CPMs.

Similarly, CNMs are trained nurses who often work in hospitals or clinics, but most are not covered under liability insurance to perform home births.

Direct-entry midwives are not certified, and often have no medical, nursing, or midwife training.  In essence, anyone can be a direct-entry midwife, and it is up to expectant parents to determine if their classification as a midwife is supported by adequate training and experience.

Home Birth Risks

Having a baby is a wonderful experience, albeit very unpredictable.  Even with careful planning the labor and delivery process can become complicated, emergent, or traumatic.

In the case of home births, if a physician or licensed nurse is not present, there are several risks, including:

  • Lack of proper vital sign monitoring equipment
  • Inability to legally obtain or administer medications like Pitocin, antibiotics, RhoGAM, or IV fluids
  • Lack of knowledge regarding warning signs of complications
  • Lack of training in how to manage emergent situations

When labor and delivery go awry, there is an increased chance of the mother and child suffering injuries.  While midwifery is certainly a respected profession, expectant parents should use caution when relying on a midwife they are unfamiliar with, or trusting a title without documentation to support proper training.

When Home Births go Awry

When home births go awry, it is up to those attending the situation (midwives, nurses, etc.) to assess the situation and respond with treatment as soon as possible.

Unfortunately, that does not always happen.

In the past few years, there have been a series of legal cases arise after home births or births attended by midwives and not physicians resulted in tragic outcomes.  A few of these examples include:

  • In 2003, a woman was taken to a hospital with severe labor pains. Due to a previous complicated pregnancy and c-section delivery, she was considered “high risk”, and was advised to see a physician rather than a midwife.  At the hospital, however, a midwife presided over the entire labor and delivery process, not calling in a physician until the situation became emergent.  As a result, the baby suffered severe injuries and is permanently disabled.  In 2007, the family was awarded $24.5 million in a birth injury lawsuit.
  • In 2011, a Michigan woman began the delivery process at a midwifery clinic. She had previously been informed that the baby was breech, but her midwife assured her that a vaginal delivery was safe.  When labor began, however, the baby became stuck in the birth canal, with his head still inside.  He remained in this position for almost seven minutes while the midwife worked to free him.  Paramedics were called after birth due to the lifeless, blue nature of the child, and he was admitted to NICU.  He died thirteen days later due to severe brain damage and organ failure.  In May 2014, his parents were awarded $5 million in a lawsuit against the midwife.
  • In 2012, a woman was told she was a good candidate for a water birth, even though she was considered high risk. During delivery, midwives failed to properly monitor vital signs, which would have revealed abnormal fetal heart rates during delivery.  After being removed from the tub, the baby was delivered, but he had been deprived of blood and oxygen for long enough that he suffered permanent damage leading to cerebral palsy.  In May 2016, the now 4-year-old’s family was awarded $13 million in a birth malpractice case.

Home Birth Safety and Legal Rules

The laws and standards concerning home births and midwives vary from state-to-state.  If you are considering having a home birth, there are several important factors that you should consider, such as the following:

  • High Risk Pregnancy – Before deciding on a home birth, it is important that you know whether your pregnancy is considered “high risk”. High risk pregnancies often result in the need for more intense medical monitoring, and are more likely to require cesarean section (c-section) delivery, medications, or physician intervention.
  • State Laws/Regulations – Before you make the decision to have a home birth, you should also explore state laws and regulations relating to home births, midwives, and what happens if you require a physician to be involved.
  • Research Midwives – Before selecting a midwife, explore your state’s licensure information and regulation. Further, it is important to make sure that your prospective midwife has not previously been involved in a medical malpractice lawsuit, criminal charges, or birth injury negligence actions by regulating boards.
  • Short List Recommendations – Once you have a few prospective midwives in mind, conduct some further research into factors like malpractice insurance coverage. It is generally recommended that midwives have at least $5 million in malpractice insurance to protect you if something goes wrong, or she makes a mistake.
  • Have a Backup Plan – Even the most careful, well-planned labor and delivery can go awry. It is important to have a backup plan, especially if you are planning a home birth.  Find out if your midwife is legally allowed to bring medications and equipment, such as a Doppler, oxygen tank, and fetal monitoring equipment.  If not, what is the plan should complications arise? Does your midwife have an obstetrician on call? Is there a nearby hospital suitable to manage an emergent delivery situation?
  • Speak with an Attorney – If you are unsure of your state’s laws about midwifery, or your baby was injured during a home birth or other midwife attended birth experience, you may also find it helpful to speak with a birth injury attorney. Birth injury attorneys can help you understand the law, your rights, and what you can do if you and your family have been touched by negligence.