Last year, Hilary Duff’s Instagram post about her home birth drew tons of attention, showing the singer in a birthing tub, cradling her new baby with a support team nearby.
The post shared the joys of a successful birth, but the comments revealed a spark of controversy. One person wrote: “My baby didn’t breathe for the first 5 full min, if I had a home birth she would not be here with us today.”
The actor’s delivery reflects a larger trend toward alternative birth practices, including home birth, which has risen 60% over the past seven years. Interest in alternative births has also been tied to mistrust in the mainstream U.S. healthcare system due to factors like an increase in c-sections, disproportionate rates of non-white maternal deaths in hospitals, and implicit bias in medical care. As alternative practices increase in popularity, doctors are concerned about the influence of social media posts that don’t always tell the whole story.
“It’s important to share information and give evidence to show that this is not all rainbows and sunshine,” said Dr. Dawn Nolt, a pediatrician at OHSU Doernbecher Children’s Hospital and author of a pediatrics report on alternative perinatal practices. “There are risks to some of these things.”
Many alternative birth practices have not been studied comprehensively. That said, there is enough observational research to provide patients with helpful information.
“We want people to seek care when they need it and not feel like they are going to be silenced if they’d like to bring up some of these more alternate ways that they’d like to approach their care,” said Dr. Melissa Dennis, OB/GYN and chief medical officer at Patrum Health.
We talked with Nolt, Dennis and other physicians about four alternative birth practices and what parents need to know to keep themselves and their baby safe.
Water Birth
Water birth involves laboring in a water-filled tub, then delivering the baby into the water and slowly bringing it to the surface.
Research shows that this can increase comfort in early labor, but there are no conclusive benefits after that. The American College of Obstetrics and Gynecology (ACOG) recommends leaving the tub after early labor and delivering “on land.” It can be difficult to move sometimes, and labor can progress faster than expected.
“I think it’s uncomfortable to move, and that could be why many birth parents stay in the water [through delivery],” Nolt said. “There’s also this idea that the transition for the baby from inside the uterus … out into the real world still buffeted by water might be appealing, but there’s no evidence showing that it decreases any sort of trauma to the baby.”
The ACOG has reported that water birth cases are showing significant risks to the baby in the second stage of labor.
“There are literature reports of babies getting infected or taking their first breaths [under] the water and having complications,” Dennis said. “So when a patient is looking at wanting to actually push in the water, there are really important things that they should look for. One is to make sure they are delivering with a provider who is really experienced in water birth.”
The provider must understand how to minimize the chances of infection, prevent umbilical cord “snapping,” and avoid water aspiration.
Patients should also verify how the tub will be cleaned and other critical safety points.
“It’s really important for a patient to ask, ‘How will you be monitoring me in the water? How will you be checking my vital signs and the baby’s heartbeat?’” Dennis said. “You also need to be aware of the emergency plan. Let’s say you’re pushing, and there are signs of complications. What’s the next step? How will they get you out of the water, and where will they bring you?”
Freebirth
A famous water birth took place in 2022 in the ocean and was also a freebirth. The mom, Josy Peukert, traveled from Germany to Nicaragua to give birth in the Pacific Ocean, according to The New York Post. The only person in attendance was her husband, who filmed a video which later went viral on Instagram.
Freebirth means that the birthing parent delivers the baby without medical assistance.
Freebirth is different from home birth, like Duff’s, with a trained nurse or midwife present, and it is also separate from delivery at an unplanned location due to the baby arriving before the mother could reach the hospital.
“Freebirth is unnecessarily dangerous and risky: I do not support it,”Dr. Nicole Rankins, host of “All About Pregnancy & Birth” podcast, told HuffPost via email. “I support hospital births as well as community births (home or birth center) with a trained birth attendant. All of these options have a low risk of complications and have someone present who can address complications.”
The ACOG warns that although home births typically have fewer maternal interventions, the risk of perinatal death is more than twice as likely to occur compared to birth in a hospital setting. There’s also triple the risk of neonatal seizures or serious neurologic dysfunction.
“Midwives have been around for centuries for a reason,” Rankins said. “Having someone present who understands birth and can address potential problems is lifesaving.”
Rankins noted that having a midwife attend to a home birth is essential. She partners with midwives in her community to provide a safe place for transfer to the hospital when needed.
Dennis shared that she has personally witnessed devastating outcomes from freebirths and is concerned that social media has glamorized the trend, causing some people to forgo medical resources that they could have otherwise accessed.
“I understand and appreciate that there is mistrust in medicine … but there are ways to have an unmedicated, natural experience while still having medical support to ensure a safer and better outcome for you and the baby,” Dennis said. “If someone is considering a freebirth, I would encourage them to really ask themselves why and explore deeply what they are trying to gain … and see if there are ways that it can be accomplished by still being supported by someone who is licensed to practice medicine.”
Lotus Birth
Like freebirth, lotus birth appeals to those who seek natural experiences. A lotus birth involves leaving the baby attached to the umbilical cord and placenta until they fall off, which can take as few as five days and up to 15 days. The placenta is typically covered with salt and herbs to minimize odor and is carried close to the baby in a bag.
The ACOG and the American Academy of Pediatrics (AAP) have not taken a position on lotus birth, and the practice has not been fully studied. However, the AAP released Nolt’s report in its journal, Pediatrics, to help physicians understand the practice and treat patients who may have been involved in a lotus birth.
“In our research, the impetus for lotus birth … is the idea that there is a spiritual connection of the placenta to the baby and that there needs to be a nonviolent separation of those two entities,” Nolt said.
This spiritual connection is hard to prove or disprove, and Nolt said that medical professionals are expected to follow proven practices.
“We as physicians try to think more about what science there is and risk/benefit to the baby,” she said.
The report found no evidence-based benefit to babies with lotus birth. Risks include infection from the dead tissue, tearing of the umbilical cord and jaundice.
Proponents of lotus birth have noted the advantages of extra blood flowing from the placenta to the baby, but the same outcome can be achieved by delayed clamping of the umbilical cord, a standard practice when there is no distress.
Cannabis For Morning Sickness
Cannabis has been used to ease nausea for thousands of years, so it’s not entirely surprising that people have tried it to treat morning sickness — but physicians warn against it. Despite this, a recent analysis examined 90,000 umbilical cords sampled from 2019-2023 and found that 20% tested positive for cannabis.
“I suffered from hyperemesis gravidarum and was so miserable that I probably would have tried almost anything to feel better, but I’ll tell you, that would not have included marijuana,” Dennis said. “That’s because there is no demonstrated safe level of marijuana in pregnancy.” Hyperemesis gravidarum is a rare form of morning sickness that causes persistent vomiting that can lead to dehydration and other medical issues. It is typically treated with anti-nausea prescription medications.
Dennis pointed out that it would be unethical to clinically test cannabis use during pregnancy, but collected case reports have demonstrated the outcomes.
“We have found historically, and continue to find now, that there are higher numbers of people who have early pregnancy exposure to marijuana, that there is no safe level,” Dennis said. “It does increase the rate of adverse pregnancy outcomes, including smaller birth weight. Depending on how much someone is using and how long they are using throughout pregnancy, there can be withdrawal in newborns.”
Cannabis use during pregnancy has also been tied to abnormal brain development and other complications, but more research is needed. Conclusive outcomes are difficult to determine given the many variables involved: How was it ingested? Was alcohol, nicotine, opioids or other drugs used as well?
For those suffering from morning sickness, there are medications and other treatments that have been clinically tested.
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“Start with dietary changes like small, frequent meals to keep your stomach from getting too full or too empty. Eat blander foods and protein-rich foods like nuts or yogurt,” Rankins said via email. “You can also do vitamin B6, ginger, and acupressure wrist bands for the P6 point. If those methods don’t work, prescription medications may be needed. Also, remember that most nausea is short term and will resolve by 14-16 weeks.”