The American College of Obstetricians and Gynecologists (ACOG) issued a Committee Opinion that says that a prior cesarean delivery is an absolute contraindication to planning a home birth due to the risks, including uterine rupture.
The statement says that although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births. A review of the data also found that planned home births among low risk women are associated with fewer medical interventions than planned hospital births.
Although The ACOG does not support planned home births given the published medical data, it emphasizes that women who decide to deliver at home should be offered standard components of prenatal care, including Group B Strep screening and treatment, genetic screening, and HIV screening.
It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency.
The recommendations state Women who want to try for a vaginal birth after cesarean are advised to do so only in a hospital where emergency care is immediately available. Attempting a home birth also is not advised for women who are post term (greater than 42 weeks gestation), carrying twins, or have a breech presentation because all carry a greater risk of perinatal death.
Committee Opinion #476, "Planned Home Birth," is published in the February 2011 issue of Obstetrics & Gynecology.
American College of Obstetricians and Gynecologists