Guidelines on Minimum Requirements for Healthy Home Birth

Lara C. Pullen, PhD

April 29, 2013

The American Academy of Pediatrics (AAP) has issued a position paper in support of the American College of Obstetricians and Gynecologists' statement affirming that the safest places for births are hospitals and birthing centers. The AAP acknowledges, however, that women have the right to make a medically informed decision about delivery.

The AAP position paper, written by Kristi L. Watterberg, MD, and other members of the AAP's Committee on Fetus and Newborn, was published online April 29 in Pediatrics. The statement is intended to reinforce the AAP's belief that every newborn infant deserves a high standard of healthcare.

Although home births are not common, the rate of home births is increasing in the United States. The AAP statement is meant to help pediatricians inform mothers-to-be about the standards of care for newborn infants. A single message, delivered by obstetricians and pediatricians, can help in the delivery of high-quality care to all newborn infants.

The AAP and American Heart Association both recommend that at every delivery there be a person dedicated to the care of the newborn infant. This care should follow the Guidelines for Perinatal Care published by the AAP and include providing warmth, appropriate resuscitation, and assignment of Apgar scores.

The new AAP position statement on home births reviews these guidelines and explains that all pregnant women should be screened for group B streptococcal colonization and colonized women should receive 4 or more hours of intravenous antibiotic. Infants with abnormal fetal growth or whose mothers have diabetes are at risk for hypoglycemia and other neonatal complications. All newborns should be kept warm during the first 4 to 8 hours and given a detailed physical examination.

Newborns should receive prophylaxis against gonococcal ophthalmia neonatorum. Newborn infants also should receive a parenteral dose of natural vitamin K1 oxide to prevent vitamin K–dependent hemorrhagic disease of the newborn. Stable newborns who weigh more than 2 kg should receive an early hepatitis B vaccination.

Pediatrics. Published online April 29, 2013.