Stating that home birth is a legal right in Turkey, Dr. Tuğba Yılmaz Esencan, a faculty member of the Midwifery Department at the Faculty of Health Sciences, said, “No law prohibits a woman from giving birth to her baby at home. However, in practice, the situation is slightly different. The Ministry of Health recommends that births take place in a hospital environment, and state-guaranteed birth services are almost exclusively limited to hospitals.”
Dr. Tuğba Yılmaz Esencan: “Recent studies have reported that unplanned home births have insufficient prenatal care, a higher need for neonatal intensive care, and higher maternal mortality rates. Home birth is not recommended, especially for women with breech presentation, multiple pregnancies, or a history of previous cesarean section.”
Dr. Tuğba Yılmaz Esencan, Vice Dean of the Faculty of Health Sciences and a faculty member from the Midwifery Department at Üsküdar Üniversitesi, stated that “Midwives Week,” celebrated between April 21-28, offers an important opportunity to draw attention to the importance of the midwifery profession and raise awareness in this field, addressing the issue of home birth and returning to the nature of birth.
Is home birth legal in Turkey?
Stating that the topic of home birth, which is increasingly discussed on this year's agenda, Dr. Tuğba Yılmaz Esencan said, “Home birth is a legal right in Turkey. No law prohibits a woman from giving birth to her baby at home. However, in practice, the situation is slightly different. The Ministry of Health recommends that births take place in a hospital environment, and state-guaranteed birth services are almost exclusively limited to hospitals. Therefore, a woman who wishes to have a home birth must find a trained midwife and an obstetrician-gynecologist through her own means. This situation, despite being a legal right, makes the widespread adoption of the practice difficult.”
Pros and Cons of Home Birth
Explaining that planned home births can be safe when well-prepared for birth, in low-risk pregnancies, with appropriate home birth conditions provided by midwives, and when the conditions do not pose a risk for home birth, Dr. Tuğba Yılmaz Esencan continued:
“Among the main reasons women prefer home birth are; being able to control the birth environment, avoiding unwanted medical interventions, giving birth in a calmer environment, and taking an active role in birth. Additionally, in planned home births; interventions such as C-sections, labor induction, and episiotomy are less frequently applied. In contrast, unplanned or risky home births can carry serious health risks for both mother and baby. Recent studies have reported that unplanned home births have insufficient prenatal care, a higher need for neonatal intensive care, and higher maternal mortality rates. Home birth is not recommended, especially for women with breech presentation, multiple pregnancies, or a history of previous cesarean section.”
Is Home Birth Safe?
Noting that non-interventional and woman-centered approaches, which respect the natural process of birth, have been gaining increasing interest in recent years, Dr. Tuğba Yılmaz Esencan said, “In this context, the question 'Is home birth safe?' is frequently asked by both expectant mothers and healthcare professionals. The answer is; Yes, it can be safe, but with certain conditions. A comprehensive systematic review and meta-analysis published in The Lancet in 2019, which included data from approximately 500,000 births, revealed no significant difference in neonatal or perinatal mortality rates between planned home births and hospital births. This finding strongly supports that home birth is safe as long as the birth occurs within well-integrated healthcare systems and with the accompaniment of trained midwives.”
What Happens in Emergencies?
Stating that trained midwives work with the equipment and medications necessary to perform emergency interventions during birth, Dr. Tuğba Yılmaz Esencan said, “Organization is provided for rapid hospital transfer when needed. Indeed, a study conducted in the Netherlands showed that even in a serious situation like postpartum hemorrhage, all mothers fully recovered with the effective intervention of midwives. According to a Cochrane Review published in 2023, planned hospital births do not always yield better outcomes in uncomplicated pregnancies; on the contrary, they can be associated with more interventions, C-sections, and neonatal problems.”
Benefits of Home Birth
Pointing out that home birth provides not only physical but also psychological and social benefits, Dr. Tuğba Yılmaz Esencan said, “A study conducted in England and Ireland showed that women who gave birth at home had higher breastfeeding rates. Furthermore, fathers who witnessed home births described the experience as ‘magical’ and ‘transformative’. Home birth can be a safe alternative when planned in low-risk pregnancies, within appropriate healthcare systems, and with the accompaniment of trained healthcare professionals. Accessing accurate information on this matter and enabling women to make informed choices is of great importance for maternal and infant health. In Turkey, home birth is also legally possible; meaning no woman faces criminal or legal sanctions for deciding to give birth at home. However, the Ministry of Health's approach encourages births to be carried out in healthcare facilities such as hospitals, with expert healthcare personnel.”
The Midwifery Profession: 'Living Cultural Heritage'…
Dr. Tuğba Yılmaz Esencan stated that the midwifery profession plays a crucial role not only during childbirth but also in processes such as pre-pregnancy education, pregnancy monitoring, birth management, and postpartum care, reminding that UNESCO defines the midwifery profession as “living cultural heritage.”
Noting that although the midwifery department has been among the most preferred departments among university candidates in Turkey in recent years, many midwives still work in less visible conditions in the field, Dr. Tuğba Yılmaz Esencan said that midwives are not only those who perform births; they are professionals who holistically support women's, infant, and public health.
International Approaches…
Emphasizing that approaches to birth and midwifery services vary greatly in different countries around the world, Dr. Tuğba Yılmaz Esencan said, “These differences are mostly shaped by countries' healthcare systems, the meaning attributed to birth, the woman's role in birth, and the trust placed in healthcare professionals. Especially in developed countries, home birth has begun to regain importance as an option.”
The concept of “controlled, sterile, medical birth” is now being questioned
Noting that the centuries-old understanding of “controlled, sterile, medical birth” is now also being questioned, Dr. Tuğba Yılmaz Esencan concluded, “As interest in topics like natural living, healthy eating, and organic living increases, so does the demand for a ‘natural’ approach to birth. Women's desire to have more say in childbirth brings home birth back onto the agenda. However, for this process to be carried out safely, there is a need for legal regulations, strengthening the midwifery system, insuring midwives against malpractice, and increasing public awareness. Investing in a midwife is an investment in women and society. Midwives do not just deliver babies; they witness women's birthing power and represent the humane face of the healthcare system.”