American Academy of Pediatrics Issues Safety Recommendations on Home Births; Hospitals Remain the Safest Option Even Amid Coronavirus Pandemic

Evidence points to safer outcomes for infants delivered in a medical setting.

The American Academy of Pediatrics has updated its recommendations for the birth of infants at home, while emphasizing that the AAP believes the safest birth remains at a hospital.

“We recognize that women have different reasons for planning a home delivery, such as cultural or religious beliefs – and right now, concerns over the coronavirus pandemic ,” said Kristi L. Watterberg, MD, FAAP, lead author of the policy statement, “ Providing Care for Infants Born at Home.”

“We are providing information for physicians to share with expectant parents to help them understand the factors that increase the risks of home birth and recommend standards for newborn care. If a medical emergency does arise during birth at home, families should also be aware of the very real risk that emergency transport services could be unavailable due to the coronavirus response.”

The policy statement, published in the May 2020 Pediatrics (published online April 20), was written by the AAP Committee on Fetus and Newborn as an update to recommendations made in 2013. The statement reiterates that hospitals and accredited birth centers remain the safest settings for births in the U.S.

Planned home birth in the U.S. has been associated with a two- to three-fold increase in infant mortality, as well as increased risks associated with medical complications, according to the statement. Yet more women are giving birth at home, with the increase seen mostly in white non-Hispanic women, research shows. More than 2% of births to these women take place at home, although this varies across states.

The AAP recommends that those who consider home births meet all these criteria:

• Have a low-risk pregnancy
• Have certified personnel who would attend the birth and a pre-established network in case of transfer to a hospital. 
• Ensure that the care of infants born at home be consistent with that provided for infants born in a medical facility. 
• Arrange for two care providers to be present at each delivery. At least one should have primary responsibility for the newborn and appropriate training, skills and equipment to perform full resuscitation of the infant according to the Neonatal Resuscitation Program.

Expectant mothers with questions about hospital safety during the pandemic should talk over their concerns with their physicians in advance. 

The AAP and American College of Obstetricians and Gynecologists support the provision of care by midwives who are certified by the American Midwifery Certification Board (or its predecessor organizations) or whose education and licensure meet the International Confederation of Midwives Global Standards for Midwifery Education.

“Our primary concern is always for the mother and baby’s safety, care and comfort,” Dr. Watterberg said. “We are here to support parents with the information they need to make the best decision for their families.”