A mother planning a home birth

by Jacqueline George

10/31/2023

When you live too far from the hospital for a home birth and you also live too far from the hospital for a hospital birth… 🥴

This is one example of why it’s problematic to apply hospital-based policies to community-based birth. In this case, it’s become a standard of care in many communities for midwives to stipulate that their client’s chosen birth space be within 30 minutes of a hospital. This is particularly true in the case of mothers planning an HBAC and it’s born in large part out of this “decision to incision” time from the medical model. Not only is this unrealistic for many families who live long distances from a hospital already, but studies have shown that applying a blanket “decision to incision” practice guideline is lacking in supporting evidence for its use beyond simple benchmarking.

One study published in Obstetrics & Gynecology in 2023 showed that hospitals exceeded this 30-minute benchmark 67% of the time, even when those cesareans were deemed “urgent.” The AJOG study, also from 2023, criticized the fact that there is no “standardized” definition of what classifies a “stat” versus “urgent” versus “emergency” cesarean, but these terms are used frequently in documentation regardless. They also recommend individualizing the “decision to incision” interval based on each mother’s and baby’s specific situation (imagine that…individualization of care). They note that in some cases, 30 minutes may be too long, but that in many others, there is sufficient time beyond that benchmark.

“It has been suggested that treatment within a specified time frame improves clinical outcomes. However, through our review of the literature, there remains insufficient evidence to support a time frame for the decision-to-delivery interval.” AJOG, 2023.

Were you advised against a home birth due to your location or distance from services? Do your licensure regulations or community standards dictate this kind of location-based limitation? Let me know!