Home Birth and the Risk of Future Disability to a Child

Author: BMJ-British Medical Journal
Published: 24 Jan 2014 - Updated: 5 Jul 2026
Publication Details: Peer-Reviewed | Research, Study, Analysis

Table of Contents:
Synopsis - Definition - Introduction - Main - FAQ's - Insights, Updates - Related Publications

Synopsis: This research examines an ethical analysis, published in the peer-reviewed Journal of Medical Ethics, that argues the risk of long-term disability to the child should carry significant weight in any decision about whether to give birth at home or in a hospital. Written up by the BMJ and authored by Oxford University ethicist Professor Julian Savulescu and obstetrician Associate Professor Lachlan de Crespigny of the University of Melbourne, the work is useful because it shifts the home-birth safety debate beyond the question of death alone to include the possibility of lifelong disability - a consideration the authors say has often been overlooked. For expectant parents, healthcare professionals, and members of the disability community, it offers an evidence-informed perspective on why fully informed choice matters when birth complications can have consequences that may not become apparent for years.*

At a Glance

• 1 - The authors note that hospital births carry their own risks and that home birth is often viewed as a more natural, less interventionist option.
• 2 - There is comparatively little evidence on the long-term outcomes of children born at home, a gap the authors say must be addressed so women and doctors are better informed.
• 3 - Available research points to increased risks of death, disability, and admission to neonatal intensive care compared with hospital births, with even small delays in accessing care potentially having lifelong implications.

Topic Definition: Home Birth

Home birth is the practice of giving birth outside of a hospital or dedicated birthing center, typically in the mother's own residence, often with the assistance of a midwife and sometimes attended by a doctor or trained birth supporter. It is frequently chosen by women seeking a more natural, familiar, and less medically interventionist setting for labor and delivery. While many home births proceed without difficulty, the approach remains the subject of ongoing medical and ethical debate because rapid access to specialist care can be limited if complications arise, raising questions about the balance between personal choice and the safety of both mother and child.

Introduction

The risk of future long term disability to the child should "weigh heavily" in decisions about whether to give birth at home or in hospital, argue leading ethicists in the Journal of Medical Ethics. Women should, of course, be free to choose where they want to give birth, insist Oxford University ethicist Professor Julian Savulescu and obstetrician and gynecologist Associate Professor Lachlan de Crespigny of the University of Melbourne.

But to date, the arguments around the safety of home-birth have focused on the risk of death, ignoring the possibility of long term disability to the future child an equally relevant consideration, they argue. As a result, women and their partners may be poorly informed of all the potential risks they could be taking by choosing a home-birth, they say.

Main Content

There is comparatively little evidence on the long term outcomes of children born at home. And this is a deficit that needs to be addressed, to ensure that both women and their doctors are better informed, argue both authors in an accompanying podcast.

But the available research indicates that there are "a number of reasons to be concerned," they say in the podcast, as they point to increased risks of death, disability, and admission to neonatal intensive care compared with hospital births.

If complications arise during birth, it is vital that mother and baby can access immediate medical expertise to ensure the long term wellbeing of both, they say. Even small delays can be crucial and have lifelong implications. And inevitably, there will be few resources available to pick up and manage these complications at home, they point out.

"When a baby is injured during childbirth, the full extent of the harm is often not obvious until years later," they warn, adding: "Actions taken today that cause harm in the future are as wrong as if that harm were realized today."

The authors acknowledge that hospital births are not without their own risks, and that home-birth is often seen as a more natural and less interventionist alternative.

"However, labor and delivery is a time of high risk, and home-birth may expose the future child to unreasonable risk of potentially life-changing disability for benefits that may be comparatively small," they argue.

In the podcast, Professor Savulescu argues strongly that hospitals need to do far more to make their environments more attractive and acceptable to women, while healthcare professionals should ensure that mums to be are fully informed of the potential risks of a home-birth.

Frequently Asked Questions

Who is generally considered a poor candidate for a home birth?

Pregnancies described as higher risk are usually considered less suitable for home birth, including those involving twins or other multiples, a baby positioned breech, a previous cesarean section, pre-eclampsia, gestational diabetes, or a delivery that begins significantly preterm. Because these situations raise the chance of complications that need rapid specialist intervention, many clinicians recommend a hospital or dedicated birthing center for them.

What should a home birth transfer plan include in case of an emergency?

A sound transfer plan identifies the nearest hospital with obstetric and neonatal facilities, the realistic travel time to reach it, and a pre-arranged route or ambulance arrangement so that no time is lost deciding what to do. It also covers who will accompany the mother, what medical notes and history will travel with her, and clear thresholds agreed in advance for when a transfer should be triggered rather than delayed.

What qualifications should I look for in a home birth midwife?

Look for a midwife who is formally registered or licensed with the relevant national or regional regulatory body, as this confirms accredited training and accountability. It is also reasonable to ask about their experience with home births specifically, their current certification in newborn and adult resuscitation, the equipment they carry, and how they coordinate with local hospitals should a transfer become necessary.

Does insurance or local regulation affect whether I can have a planned home birth?

Coverage and legal status vary widely between countries and even between regions within the same country, so a planned home birth that is fully supported in one place may be restricted, unfunded, or discouraged in another. It is worth confirming in advance whether your health system or insurer covers midwife attendance and any resulting hospital transfer, since these arrangements can influence both cost and the availability of qualified attendants.

How can parents watch for signs of a birth-related injury that appears later in childhood?

Because some injuries sustained around the time of birth are not apparent immediately, parents can stay alert to developmental milestones such as sitting, crawling, walking, and early speech, and note any persistent delays or asymmetries in movement. Sharing the full birth history with a pediatrician and raising concerns early allows for timely assessment, since earlier recognition of any difficulty generally supports better long-term support and management.

Insights, Analysis, and Developments

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by BMJ-British Medical Journal and published on 24 Jan 2014, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.